The AABB has updated their clinical practice guidelines regarding RBC transfusion thresholds. The guidelines are based on data from 45 randomized trials in adults and 7 in children. The updated guidelines are similar to previously published guidelines that recommended a restrictive transfusion threshold (hemoglobin less than 7 g/dL) for most adult hospitalized patients who are hemodynamically stable. The updated AABB guidelines, however, now also recommend a restrictive RBC transfusion threshold (hemoglobin less than 7 g/dL) for hospitalized adult hematology-oncology patients and hemodynamically stable critically ill children. Notably, per the updated guidelines, the restrictive RBC transfusion threshold is a range of 7 to 9 g/dL for pediatric patients with congenital heart disease based on the abnormality and surgical repair. Furthermore, the AABB opted not to make RBC transfusion recommendations for patients with acute myocardial infarction noting that a large, randomized clinical trial comparing transfusion thresholds in these patients in nearing completion. The AABB also noted gaps in transfusion threshold data for specific subgroups of patients including pregnant women and people with myelodysplastic syndromes.
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