Blood Transfusion in Heart Failure Patients

Transfusion Thresholds for Heart Failure

The American College of Physicians recommends transfusing heart failure patients at a hemoglobin threshold of ≤8 g/dL or when symptoms of anemia develop, such as chest pain, orthostatic hypotension, or worsening heart failure, with a strength of evidence based on moderate-quality evidence from the AABB guidelines (2012) and American College of Physicians guidelines (2013) 1, 2, 3
Hemoglobin-based triggers for transfusion in hemodynamically stable patients with preexisting cardiovascular disease, including heart failure, are recommended at ≤8 g/dL, which is higher than the 7 g/dL used for most hospitalized patients without cardiovascular disease, based on evidence from the Annals of Internal Medicine (2012, 2013) 1, 2, 3

The American College of Physicians suggests administering one unit of packed red blood cells at a time, with reassessment between units to minimize volume overload risk, based on moderate-quality evidence from the Annals of Internal Medicine (2012, 2013) 1, 2, 3
Each unit of transfused blood is expected to increase hemoglobin by approximately 1-1.5 g/dL, according to the Annals of Internal Medicine (2013) 3

The American College of Physicians recommends monitoring for symptoms of anemia, such as chest pain, dyspnea, orthostatic symptoms, and tachycardia, and checking hemoglobin daily or more frequently if clinical status changes, based on moderate-quality evidence from the Annals of Internal Medicine (2012, 2013) 1, 2, 3
Assessing for signs of volume overload, such as jugular venous distension, pulmonary crackles, and peripheral edema, is also recommended, based on evidence from the Annals of Internal Medicine (2013) 3

The American College of Physicians advises against transfusing to hemoglobin >10 g/dL, as this increases risks of nosocomial infections, multi-organ failure, transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload without providing benefit, based on moderate-quality evidence from the Annals of Internal Medicine (2012, 2013) 1, 2, 3
Liberal transfusion strategies have not shown improved outcomes and may increase complications, according to the American College of Physicians guidelines (2013) 3