The AABB has recently published updated guidelines for red blood cell (RBC) transfusion thresholds and the optimal length of storage. Based on a comprehensive systematic review and meta-analysis incorporating 31 randomized controlled trials, the AABB strongly recommends a restrictive hemoglobin transfusion threshold of 7g/dL for hemodynamically stable adult patients and 8 g/dl for patients undergoing orthopedic surgery, cardiac surgery or those with pre-existing cardiovascular disease. Notably, this recommendation does not apply to acute coronary syndrome patients nor those with severe thrombocytopenia or chronic transfusion-dependent anemia. Using evidence from 13 randomized controlled trials, AABB recommends that standard issue RBCs should continue to be issued and transfused since fresher RBCs (stored <10 days) do not improve clinical outcomes.
Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, Gernsheimer T, Holcomb JB, Kaplan LJ, Katz LM, Peterson N, Ramsey G, Rao SV, Roback JD, Shander A, Tobian AAR. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA. [e-published 12 Oct 2016].