Several randomized clinical trials demonstrated restrictive RBC transfusion approaches are safe for patients over the short-term. Many patients with moderate anemia (hemoglobin between 7 g/dL and 10 g/dL) no longer receive RBC transfusions, and the long-term consequences of restrictive RBC transfusions have not been thoroughly examined. Researchers in Northern California retrospectively examined data on all adult non-obstetric patients discharged from 21 hospitals from January 2010 until December 2014—a period when restrictive RBC transfusion practices were implemented. Based on 801,261 hospitalizations of 445,371 patients, the prevalence of moderate anemia increased from 20% to 25% over the 5 year study (P<0.001), while RBC transfusions decreased from 39.8 to 28.5 units per 1000 patients (P<0.001). While moderate anemia was less likely to resolve within 6 months, patients with moderate anemia also received fewer RBC transfusions and were less likely to be re-hospitalized or to die within the same time-frame. Although these data support the long-term safety of a restrictive RBC transfusion approach for most adult patients, additional data for specific subpopulations of patients may be warranted.
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