REVIEW OF PUBLISHED RECOMMENDATIONS AND GUIDELINES FOR THE TRANSFUSION OF ALLOGENEIC RED-BLOOD-CELLS AND PLASMA

Objective: To evaluate published guidelines and recommendations for th e transfusion of allogeneic red blood cells and plasma in terms of con tent and methods. Evidence: Bibliographic search of MEDLINE database f or articles making therapeutic recommendations regarding erythrocyte a nd plasma transfusion, between January 1966 and July 1996; manual sear ch of bibliographies from relevant reviews, guidelines and textbooks. Data synthesis: Evaluation focused on how the evidence was identified, selected and incorporated. Therapeutic recommendations were compared and contrasted. Time trends related to transfusion triggers were also examined. Results: The 59 references that met our criteria consisted o f 17 clinical practice guidelines (CPGs) and 42 reviews. Five CPGs add ressed the use of allogeneic red blood cells, 4 focused on fresh froze n plasma and 8 did both. All CPGs were based on the recommendations of an expert panel, although no specific consensus process was described . Among the 17 CPGs, only 1 used a computerized literature search and grading of the evidence and the strength of the individual recommendat ions. None of the CPGs cited or discussed the few available randomized , controlled clinical trials published at least 6 months earlier. For red blood cells, only 1 set of guidelines recommended a transfusion tr igger; 6 advocated a range of transfusion thresholds based on clinical judgement; 1 recommended using only clinical judgement; the 5 remaini ng guidelines did not comment on either. For plasma, guidelines recomm ended an assessment of the coagulation cascade and the risk of ongoing bleeding before administration. Conclusions: Although several agencie s have published guidelines for the use of red blood cells and plasma, rigorous, evidence-based guidelines in this area are still needed.