Blood Transfusion Guidelines

General Principles

The American College of Chest Physicians recommends a restrictive transfusion strategy (transfusing when Hb < 7 g/dL for most patients) over a liberal strategy, as it reduces unnecessary transfusions without increasing mortality or adverse outcomes 1
The Society of Critical Care Medicine suggests avoiding the use of hemoglobin level alone as a "trigger" for transfusion; consider individual patient factors including intravascular volume status, evidence of shock, duration and extent of anemia, and cardiopulmonary parameters 2, 3
The Society of Critical Care Medicine recommends that RBC transfusions should be given as single units in the absence of acute hemorrhage 2
A restrictive strategy reduces transfusion exposure by approximately 40% compared to liberal strategies, according to the American College of Physicians 4

For patients with stable cardiac disease, the American College of Chest Physicians recommends considering transfusion when Hb < 7 g/dL 2, 1
For patients undergoing cardiac surgery, a restrictive strategy (considering transfusion when Hb < 7.5 g/dL) is recommended by the American College of Chest Physicians 1
For patients with acute coronary syndromes, evidence from the Society of Critical Care Medicine and the American College of Physicians suggests that transfusion may be beneficial when Hb < 8 g/dL 2, 4

The Society of Critical Care Medicine states that RBC transfusion is associated with increased nosocomial infection rates (wound infection, pneumonia, sepsis) 2
The Society of Critical Care Medicine reports that RBC transfusion is an independent risk factor for multiple organ failure and systemic inflammatory response syndrome 2
Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated morbidity and mortality, according to the Society of Critical Care Medicine and other sources 2, 5
Other risks include transfusion-associated circulatory overload and immunomodulating effects, as noted by the American College of Chest Physicians 1

The American College of Physicians suggests that future research is needed for specific populations including patients with acute coronary syndrome, elderly medical patients, gastrointestinal bleeding, and transfusion-dependent patients 4