Tuesday, July 19, 2016

RBC transfusion in the ED

emDocs - July 18, 2016 - Author: Long B & Koyfman A - Edited by Simon E
As the AABB guidelines are ambiguous, emergency physicians should consider transfusion thresholds and weigh the risks and benefits of transfusion. If the patient is hemodynamically stable and asymptomatic, a Hgb of 7 g/dL is safe. If the patient is hemodynamically unstable and anemic, transfusion may assist the provider in stabilizing the patient.
  • The transfusion threshold of 10 g/dL has recently been questioned, as RBC transfusion is not without risks (transfusion reaction, infection, and potentially increased mortality).
  • The AABB currently recommends a transfusion threshold of 7 g/dL Hgb, though studies evaluating transfusion are small in sample size, retrospective, and observational in nature, affecting their applicability.
  • Age of products transfused likely has no effect on products administered prior to 21 days of storage, though further study is required.
  • A hemoglobin level of 7 g/dL is safe in the setting of critical illness, sepsis, gastrointestinal bleeding, and trauma.
  • The clinician at the bedside should evaluate the patient for symptoms associated with anemia and transfuse based on risks and benefits."