Red Blood Cell Transfusion in the Emergency Department

Brit Long, MD; Alex Koyfman, MD


J Emerg Med. 2016;51(2):120-130. 

In This Article


RBC transfusions have been used for many years for the treatment of anemia. Increased morbidity and mortality has been found with anemia in the setting of critical illness, trauma, surgery, and older age. The transfusion threshold of 10 g/dL has recently been questioned, and RBC transfusion is not without risks, which include transfusion reaction, infection, and potentially increased mortality. The AABB currently recommends a transfusion threshold of Hgb 7 g/dL. This evidence-based review evaluated the current literature of RBC transfusion impact on physiology, transfusion reactions, RBC product age, and transfusion thresholds. Studies evaluating transfusion are, for the most part, small in sample size, retrospective, and observational in nature, affecting their applicability. The majority of investigations have also been completed in critical care settings. Age of products transfused likely has no effect on products before 21 days of storage, but additional study is required. A Hgb level of 7 g/dL is safe in patients with critical illnesses, sepsis, gastrointestinal bleeding, and trauma. However, the provider at the bedside should evaluate the patient for symptoms associated with anemia and transfuse based on the risks and benefits.