Red blood cell transfusion strategies

Although the hemoglobin level of 100 g/L has been used for many years as th e allogeneic red blood cell (RBC) transfusion trigger, current evidence ind icates that for most patients a more restrictive transfusion strategy is at least as effective as and possibly superior to a liberal transfusion strat egy. Moreover, the available data indicate that the use of smaller volumes of allogeneic RBCs may be associated with decreased risk of morbidity and m ortality. Thus several recent studies indicate that the use of more restric tive triggers than 100 g/L does not appear to adversely affect patient outc omes. Indeed, the majority of recently published RBC transfusion guidelines recommend a more conservative and cautious approach to allogeneic RBC tran sfusion practice, primarily to reduce the risk of transfusion-related adver se effects. However, the available transfusion trigger studies do not provi de sufficient data to allow the claim that the improved outcomes observed a re the sole result of the transfusion strategy used. It is possible that th e results are the consequence of effects yet to be defined clearly. Additio nal studies will be necessary to determine the effects of RBC storage time and the presence of allogeneic leukocytes in allogeneic RBC transfusion pra ctice. Nonetheless, the available data, together with detailed information about alternatives to blood product transfusions, will enable physicians to improve outcomes in transfused patients. (C) 2001 Editions scientifiques e t medicales Elsevier SAS.