In this issue of JAMA, Carson and colleagues1 provide an important update to the red blood cell (RBC) transfusion guidelines developed in 2012 by the AABB (formerly the American Association of Blood Banks). The authors based the current guidelines and recommendations on the results of 31 randomized clinical trials (RCTs) performed in a variety of different clinical settings involving more than 12 500 patients who were randomized to receive transfusion triggered by either a hemoglobin concentration of less than 7 g/dL to 8 g/dL (restrictive strategy referred to as the conservative strategy) or a hemoglobin concentration of less than 9 g/dL to 10 g/dL (liberal strategy). The evaluation used the Grading of Recommendations Assessment, Development and Evaluation methods and appropriately considered only RCTs, thereby avoiding the invariable confounding present in observational studies examining blood transfusion. In aggregate, the analysis convincingly demonstrated that adverse consequences (mortality and major morbidity) were not more common among patients assigned to a conservative transfusion strategy compared with a liberal one. Thus, the authors of this guideline recommend a conservative transfusion policy.
Yazer MH, Triulzi DJ. AABB Red Blood Cell Transfusion GuidelinesSomething for Almost Everyone. JAMA. 2016;316(19):1984-1985. doi:10.1001/jama.2016.10887