New Guidelines Issued for Red Blood Cell Transfusions

Based on Research by UMDNJ-Robert Wood Johnson Medical School Physician

Newswise — New Brunswick, NJ -- The transfusion of red blood cells is a common treatment in clinical practice. However, the level at which they are transfused varies based not only on a patient’s health, but also is determined by what the administering physician deems appropriate. Today, the American Association of Blood Banks (AABB) has issued new guidelines, published in Annals of Internal Medicine, recommending that transfusion of red blood cells be considered at a hemoglobin threshold of 7 to 8 g/dL for stable adults and children. This recommendation to use a restrictive approach not only saves blood, but also reduces the costs related to unnecessary transfusions.

“A systematic review of published research determined that a restrictive approach to red blood cell transfusions would provide the best clinical outcomes for patients without causing harm,” said Jeffrey L. Carson, the Richard C. Reynolds Professor of Medicine at UMDNJ-Robert Wood Johnson Medical School, who chaired the guideline committee and is the first author of the guidelines found at: Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB (http://www.annals.org/content/early/2012/03/26/0003-4819-156-12-201206190-00429?aimhp). “It is important however that physicians consider other clinical conditions when determining transfusion levels to ensure patient safety.”

The AABB recommendations – four in all – are based on the systematic review of research published from 1950 to 2011 which examines the proportion of patients, both adult and children, who received any red blood cell transfusion for medical or surgical reasons, and the number of red blood cell units transfused. The guidelines also recommend a restrictive transfusion approach for patients with preexisting cardiovascular disease but indicate that it is unknown when transfusion should be given to a patient hospitalized for a heart attack. The fourth guideline recommends that the patient’s symptoms, in addition to hemoglobin levels, be considered when determining transfusion levels.

Dr. Carson was the study chair for the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair, known as FOCUS, the results of which were published in December 2011 in the New England Journal of Medicine. The results of FOCUS contributed to these guidelines as did two previously published systematic reviews of research by Dr. Carson and colleagues.

Dr. Carson developed the guidelines along with specialists in cardiology, pediatrics, critical care medicine, trauma and anesthesia who formed a 20-member panel of experts.

About UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL

As one of the nation’s leading comprehensive medical schools, UMDNJ-Robert Wood Johnson Medical School is dedicated to the pursuit of excellence in education, research, health care delivery, and the promotion of community health. In cooperation with Robert Wood Johnson University Hospital, the medical school’s principal affiliate, they comprise one of the nation's premier academic medical centers. In addition, Robert Wood Johnson Medical School has 34 other hospital affiliates and ambulatory care sites throughout the region.

As one of the eight schools of the University of Medicine and Dentistry of New Jersey with 2,800 full-time and volunteer faculty, Robert Wood Johnson Medical School encompasses 22 basic science and clinical departments, hosts centers and institutes including The Cancer Institute of New Jersey, the Child Health Institute of New Jersey, the Center for Advanced Biotechnology and Medicine, the Environmental and Occupational Health Sciences Institute, and the Stem Cell Institute of New Jersey. The medical school maintains educational programs at the undergraduate, graduate and postgraduate levels for more than 1,500 students on its campuses in New Brunswick, Piscataway, and Camden, and provides continuing education courses for health care professionals and community education programs. To learn more about UMDNJ-Robert Wood Johnson Medical School, log on to rwjms.umdnj.edu. Find us online at www.Facebook.com/RWJMS and www.twitter.com/UMDNJ_RWJMS.