To what goal should non hemorrhaging patients be transfused?

6 Aug

RAGING HYPOTHETICAL:

A 82 yo multiple myeloma pt with a CAD history is transferred from the cancer center where her Hgb was found to be 6. There is no signs of active bleeding. You give her 2 units PRBC in the ER and admit her to heme/onc.  Is that enough blood?

Hebert, Paul et al.:

Question: To what goal should non hemorrhaging patients be transfused?

Methods: 838 critical care patients were enrolled and were randomized to a HGB of 7-9 or 10-12 goal. 30 day mortality was followed.

Results: Hgb 7 vs 10

No statistically significant difference in 30-day or 60-day mortality

–On average, the restrictive groups used 54% less product

–Expert opinion improved outcomes in patients with acute MI and unstable angina with liberal approach

–Not statistically significant

Teaching Point: Transfusing patients to an H/H goal of 7/21 has no change in mortality as 10/30 and can significantly reduce the amount of blood products required.

Submitted by W. Rushton.

Reference(s): Hebert, Paul et al. “A Multicenter Randomized Controlled Clinical Trial of Transfusion Requirements in Critical Care” NEJM 2/11/199 Volume 340, No 6; picture

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