What are the AABB guidelines on red blood cell transfusions?

Updated: Apr 16, 2019
  • Author: Linda L Maerz, MD, FACS, FCCM; Chief Editor: Emmanuel C Besa, MD  more...
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The decision to transfuse red cells should be based on a logical thought process with the goal of restoration of tissue oxygenation. Therefore, transfusion of red cells logically commences under the following circumstances:

  • Clinical evidence of hypoxia/dysoxia exists, manifested by hypoperfusion, including lactic acidosis and increased base deficit (when not due to hyperchloremic metabolic acidosis). In addition, preload responsive cardiac performance must be corrected by appropriate plasma volume expansion exclusive of red cell mass restoration. In this circumstance, vasopressor and/or inotropic agents may be used to improve cardiac performance if it is judged to be inadequate, and red cell mass transfusion may be used to support end-organ oxygen delivery. 

  • Active hemorrhage associated with shock

  • Hemorrhage cannot be immediately controlled because of anatomical constraints, coagulopathy, or location in an austere environment precluding hemorrhage control, and PRBC transfusion may prolong life until hemorrhage control is accomplished.

Guidelines on red blood cell transfusions from the AABB (formerly, the American Association of Blood Banks) advise a restrictive strategy for stable adults with non-hemorrhaging anemia. [3]

Recommendations from the 2016 AABB guidelines include:

  • A restrictive RBC transfusion threshold of a hemoglobin concentration of 7 g/dL or less should be considered for hospitalized adult patients who are hemodynamically stable, including critically ill patients.
  • For patients undergoing orthopedic surgery or cardiac surgery, a restrictive RBC transfusion threshold of a hemoglobin concentration of 8 mg/dL or less should be considered.   
  • Also consider transfusion for hemoglobin concentrations of 8 g/dL or less in hospitalized patients who are hemodynamically stable with pre-existing cardiovascular disease.
  • The AABB does not recommend either a liberal or restrictive threshold for transfusion for hospitalized, hemodynamically stable patients with the acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological disorders who are at risk of bleeding), and chronic transfusion-dependent anemia

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