“To transfuse, or not to transfuse?” Jeff Carson is lead author of the 2016 AABB RBC Transfusion Threshold Guidelines, and he has terrific insights into how we should be making transfusion decisions.
Dr. Jeff Carson
What’s New?
The new guidelines have produced much discussion at national meetings and in the medical press, and Dr. Carson is here to help us understand the background of the guideline development (including the assumptions and values the committee used to work through the many new, prospective articles published since the previous guidelines were released). He also discusses the value of randomized, prospective studies of RBC transfusion thresholds vs. the many observational, retrospective studies that have been published (hint: He and the committee like one type MUCH more than the other!). Finally, Dr. Carson takes us through the RBC guidelines specifically, including why the committee elected to recommend a threshold of 7 g/dL in most cases, but 8 g/dL in a few others.
NOTE: The article also discussed the AABB Committee’s recommendations regarding the “age of blood” discussion, and whether selecting freshest available blood makes a clinical difference in recipients. Please see BBGuy Essentials Episode 022 with Professor Nancy Heddle for further discussion on that issue.
Dr. Jeff Carson
What’s New?
The new guidelines have produced much discussion at national meetings and in the medical press, and Dr. Carson is here to help us understand the background of the guideline development (including the assumptions and values the committee used to work through the many new, prospective articles published since the previous guidelines were released). He also discusses the value of randomized, prospective studies of RBC transfusion thresholds vs. the many observational, retrospective studies that have been published (hint: He and the committee like one type MUCH more than the other!). Finally, Dr. Carson takes us through the RBC guidelines specifically, including why the committee elected to recommend a threshold of 7 g/dL in most cases, but 8 g/dL in a few others.
NOTE: The article also discussed the AABB Committee’s recommendations regarding the “age of blood” discussion, and whether selecting freshest available blood makes a clinical difference in recipients. Please see BBGuy Essentials Episode 022 with Professor Nancy Heddle for further discussion on that issue.
The images below are generously provided by Dr. Carson.
Further Reading/Listening:
- 2016 AABB RBC Transfusion Thresholds: Carson JL et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016;316(19):2025-2035.
- Editorial on RBC Thresholds: Yazer MH and Triulzi DJ. AABB Red Blood Cell Transfusion Guidelines: Something for Almost Everyone. JAMA. 2016;316(19):1984-1985.
- 2012 AABB RBC Transfusion Thresholds: Carson JL et al. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med. 2012;157(1):49-58.
- Cochrane Library Article on RBC Thresholds: Carson JL et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD002042. DOI: 10.1002/14651858.CD002042.pub4.
- Previous Podcast: BBGuy Essentials 022 with Prof. Nancy Heddle on “Age of Blood”
This was super interesting!
Glad you liked it, Sandy!
-Joe
Excellent podcast as always, very enlightening and informative! I was wondering what the response might be from the experts when physicians want to give two units at once for patients with Hb in the 7-8 range. Shouldn’t they give one unit and re-assess? They may argue that they just gave blood and don’t want to draw the patient again! I love these podcasts! Next up for me is 67!
Hi Jeff. The answer is that we always encourage those ordering transfusion for non-bleeding, non-emergency patients to consider whether one unit will accomplish their goal (which they should have, whether it’s a numeric target or an improvement of symptoms). They don’t have to wait long to do it (15 minutes post-transfusion is plenty.
-Joe