PRACTICE PARAMETER FOR THE USE OF RED-BLOOD-CELL TRANSFUSIONS - DEVELOPED BY THE RED-BLOOD-CELL ADMINISTRATION PRACTICE GUIDELINE DEVELOPMENT TASK-FORCE OF THE COLLEGE-OF-AMERICAN-PATHOLOGISTS

A practice parameter has been developed to assist physicians in the th erapeutic use of red blood cell transfusions. The developers of this p arameter used the best available information from the medical literatu re, as well as clinical experience and the extensive reality testing r equired by the College of American Pathologists for approval. In acute anemia, a fall in hemoglobin values below 6 g/dL or a rapid blood vol ume loss of more than 30% to 40% requires red blood cell transfusions in most patients. However, tissue oxygenation provides a better indica tion of physiologic need in situations where invasive monitoring provi des this information. When these data are not available, heart rate an d blood pressure measurements and the nature of bleeding (active, cont rolled, uncontrolled) supplement the hemoglobin value in guiding the t ransfusion decision. In sickle cell disease and thalassemias, red bloo d cells are transfused to prevent acute or chronic complications. Red blood cell transfusions are used in chronic anemias unresponsive to ph armacologic agents based on the patients symptoms. Guidelines must be altered for neonates who require an increase in hematocrit to above 0. 30 to 0.35 when respiratory distress is present. Indications for red b lood cell transfusion for the pregnant or postpartum patient are simil ar to those for the nonpregnant patient. Risks of transfusion, particu larly transmissible disease and incompatibility, remain but have been reduced. Thus, red blood cell transfusion continues to be a powerful t herapeutic tool when used judiciously and carries less risk than in th e recent past.