Appropriateness of Allogeneic Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes
Abstract
An international multidisciplinary panel of 15 experts reviewed 494 published articles and used the RAND/UCLA Appropriateness Method to determine the appropriateness of allogeneic red blood cell (RBC) transfusion based on its expected impact on outcomes of stable nonbleeding patients in 450 typical inpatient medical, surgical, or trauma scenarios. Panelists rated allogeneic RBC transfusion as appropriate in 53 of the scenarios (11.8%), inappropriate in 267 (59.3%), and uncertain in 130 (28.9%). Red blood cell transfusion was most often rated appropriate (81%) in scenarios featuring patients with hemoglobin (Hb) level 7.9 g/dL or less, associated comorbidities, and age older than 65 years. Red blood cell transfusion was rated inappropriate in all scenarios featuring patients with Hb level 10 g/dL or more and in 71.3% of scenarios featuring patients with Hb level 8 to 9.9 g/dL. Conversely, no scenario with patient's Hb level of 8 g/dL or more was rated as appropriate. Nearly one third of all scenarios were rated uncertain, indicating the need for more research. The observation that allogeneic RBC transfusions were rated as either inappropriate or uncertain in most scenarios in this study supports a more judicious transfusion strategy. In addition, the large number of scenarios in which RBC transfusions were rated as uncertain can serve as a road map to identify areas in need of further investigation.
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The inappropriateness of blood transfusion did not change dramatically over the past 20 years.
“This issue of inappropriateness of blood transfusion did not dramatically change during the past 20 yr.[27][28][29]”
From Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients (2012) · cites this paper as [28]
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“Blood products are scarce, given their availability relies on voluntary donations 8 .”
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- Authors
- Shander, A., Fink, A., Javidroozi, M., Erhard, J., Farmer, S. L., Corwin, H., Goodnough, L. T., Hofmann, A., Isbister, J., Ozawa, S., & Spahn, D. R.
- Affiliations
- Englewood Hospital and Medical Center (US)
- Dartmouth–Hitchcock Medical Center (US)
- Stanford Medicine (US)
- Royal North Shore Hospital (AU)
- University Hospital Zurich (CH)
- Corresponding author
- Shander, Aryeh
- ORCID
- Venue
- Transfusion Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2011-07
- Volume
- 25
- Issue
- 3
- Pages
- 232-246.e53
- ISSN
- 0887-7963 (ISSN-L)
- OpenAlex
- W2069058457
- Cited by
- 216
- References
- 0
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 10 · 2023: 7 · 2022: 9 · 2021: 13 · 2020: 5 · 2019: 13 · 2018: 12 · 2017: 17 · 2016: 13 · 2015: 25 · 2014: 27 · 2013: 34 · 2012: 14
- FWCI
- 16.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transfusion Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- Eli Lilly and Company
- AstraZeneca
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Hematology › Blood groups and transfusion
- Keywords
- allogeneic red blood cell transfusion, transfusion appropriateness, hemoglobin threshold, transfusion thresholds, comorbidities, elderly patients, transfusion outcomes, expert consensus
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Algorithms, Humans, International Cooperation, Middle Aged, Quality of Health Care, Transplantation, Homologous, Treatment Outcome, Erythrocyte Transfusion
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