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January 21, 1998

Evaluating Transfusion Triggers

JAMA. 1998;279(3):238-239. doi:10.1001/jama.279.3.238

Ten years ago a National Institutes of Health Consensus Development Conference1 challenged the conventional wisdom that perioperative patients should receive red blood cell transfusion if their hemoglobin level decreased to less than 100 g/L (hematocrit <0.30). This transfusion trigger was replaced by a statement that "otherwise healthy patients with hemoglobin values of 100 g/L or greater rarely require perioperative transfusion, whereas those with acute anemia with resulting hemoglobin values of less than 70 g/L frequently will require red blood cell transfusions." In this issue of THE JOURNAL, Carson et al2 assessed the hemoglobin level at which patients were given a transfusion following surgery. In their retrospective study of 8787 patients with hip fracture who underwent surgical repair between 1983 and 1993, Carson et al2 found that only 6.6% of patients with a postoperative hemoglobin level of 100 g/L or greater received a transfusion, while 95% of patients with a hemoglobin level of less than 70 g/L received one. For patients with a hemoglobin level between 80 g/L and 99 g/L, practice varied considerably: 55.6% received a red blood cell transfusion. However, red blood cell transfusion was not associated with reduced mortality, even when the presence of underlying cardiovascular disease was considered. Although other outcome measures such as time to recovery were not studied, Carson et al2 suggest that, at least for patients in their study, red blood cell transfusion may not be necessary even for elderly patients with hemoglobin levels as low as 80 g/L.

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