In an intern
ational, multicenter, randomized trial recently published in The New England Journal of Medicine, researchers evaluated 998 septic shock patients to assess the best transfusion threshold.
There was no difference in mortality, the number of ischemic events, severe adverse reactions, or the numbers of days in the hospital between patients in the lower hemoglobin transfusion threshold group (7 g/dL) compared to those in the higher transfusion threshold group (9 g/dL). The lower-threshold group received a median of 1 unit of blood, while the higher-threshold group received a median of 4 units. By 90 days after randomization, 43% (216/502) of patients in the lower-threshold group had died compared to 45% (223/496) of the higher threshold group (relative risk, 0.94; 95% confidence interval, 0.78-1.09). Lower transfusion thresholds for septic shock patients use fewer units of RBCs and do not affect patient mortality.
References
1. Hebert PC, Carson JL. Transfusion Threshold of 7 g per Deciliter – The New Normal. N Engl J Med 2014;371(15):1459-61.
2. Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, Johansson PI, Aneman A, Vang ML, Winding R, Nebrich L, Nibro HL, Rasmussen BS, Lauridsen JR, Nielsen JS, Oldner A, Pettila V, Cronhjort MB, Andersen LH, Pedersen UG, Reiter N, Wiis J, White JO, Russell L, Thornberg KJ, Hjortrup PB, Muller RG, Moller MH, Steensen M, Tjader I, Kilsand K, Odeberg-Wernerman S, Sjobo B, Bundgaard H, Thyo MA, Lodahl D, Maerkedahl R, Albeck C, Illum D, Kruse M, Winkel P, Perner A, the TTG, the Scandinavian Critical Care Trials G. Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock. N Engl J Med 2014;371(15):1381-91.
