Unifying Concepts

Guidelines for the Clinical Use of Red Cell Transfusions

The red blood cell transfusions should not be dictated by a single hemoglobin “trigger” but instead should be based on the patient’s risks of developing complications of inadequate oxygenation. Red blood cell transfusion is rarely indicated when the hemoglobin concentration is greater than 10 g/dL and is almost always indicated when it is less than 6 g/dL.

Guidelines for red cell transfusions and volume replacement in adults
Need based on estimation of lost blood volume:
  • >40 percent loss (>2000 mL): Rapid volume replacement, including RBC transfusion, is required
  • 30 to 40 percent loss (1500 to 2000 mL): Rapid volume replacement with crystalloids or synthetic colloids is required; RBC transfusion will probably also be required
  • 15 to 30 percent loss (800 to 1500 mL): Need to transfuse crystalloids or synthetic colloids; need for RBC transfusion is unlikely unless the patient has pre-existing anemia, continuing blood loss, or reduced cardiovascular reserve
  • Less than 15 percent blood loss (</=750 mL): No need for transfusion unless volume loss is superimposed on preexisting anemia, or when patient is unable to compensate due to severe cardiac or respiratory disease
Need based on hemoglobin concentration:
  • Hgb <7 g/dL: RBC transfusion indicated. If the patient is otherwise stable, the patient should receive 2 units of packed RBC, following which the patient’s clinical status and circulating HgB should be reassessed
  • Hgb 7 to 10 g/dL: Correct strategy is unclear
  • Hgb >10 g/dL: RBC transfusion not indicated
  • High risk patients: Patients >65 and/or those with cardiovascular or respiratory disease may tolerate anemia poorly. Such patients may be transfused when Hgb <8 g/dL.
  1. Murphy MF, Wallington TB, Kelsey P, Boulton F, Bruce M, Cohen H, Duguid J, Knowles SM, Poole G, Williamson LM; British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the clinical use of red cell transfusions. Br J Haematol. 2001 Apr;113(1):24-31. [Medline]
  2. Practice Guidelines for blood component therapy: A report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology 1996; 84:732-47. [Medline]
Created: Dec 29, 2010.
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