I agree this recommendation. Thank you for interesting question and article.

Greetings from Moldova

More data

Generally when you decide to transfuse a patient, the Hb level is so low to require at least 2 blood units.

To Dr. Erika Poggiali.

What is the trigger of RBC transfusion in your institution? And this approach is available only in anesthesia or for patients from ICU to?

I agree with the ASH recommendation. The point is, in fact, that we should not rely anymore on preset thresholds of Hb concentration, but on the expected benefit from any red cells unit to be transfused, and on the Hb level that we believe to be safe for each patient. In other words, until recently when we had a patient with Hb of 7 g/dL, we were used to transfuse her/him with two units of packed red cells (PRC). The evidence for this policy isn't in and, as a matter of fact, we could harm her/him. Now, if we feel that for this single patient a hemoglobin level of 8 g/dL would be safe, we transfuse only one unit of PRC. While ensuring the safety of the patients, such a transfusional policy should result in less units transfused, less mistakes, less irregular antibodies, less direct antiglobulin positive tests, less adverse reactions, less infections, less cost and, last but not the least, less units drawn from donors. Less is more, don't you agree?

I am agree.

But, if you read the ASA reocmmendation, we could lowdown till 6 g/dL in young patient.

Also in Spain, Spanish Transfusion Society, in chronic anemia, move down till 5 g/dL, but says: first, treat correctly anemia cause.

Traasfusion is a transtory measure, and the need will re appear if cause is not treated

Transfusion decission must be tailored (personal treatment)

We must the patient, not a figure!!!

Don’t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ≥ 6 g/dL unless symptomatic or hemodynamically unstable.

The hemoglobin transfusion threshold used in multiple studies has varied from 6.0 to 10.0 g/dL. The optimal hemoglobin/hematocrit criterion for transfusion remains controversial in several clinical settings. Nevertheless, compared with higher hemoglobin thresholds, a lower hemoglobin threshold is associated with fewer red blood cell units transfused without adverse associations with mortality, cardiac morbidity, functional recovery or length of hospital stay. Hospital mortality remains lower in patients randomized to a lower hemoglobin threshold for transfusion versus those randomized to a higher hemoglobin threshold. The decision to transfuse should be based on a combination of both clinical and hemodynamic parameters.

Keep single, it is an option!

Give the minimun need dose

This is the Western Australia policy!

Watch their amanizing experience.

The first ASH recommendation: "Don’t transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac in-patients)."

Transfusion of the smallest effective dose of RBCs is recommended because liberal transfusion strategies do not improve outcomes when compared to restrictive strategies. Unnecessary transfusion generates costs and exposes patients to potential adverse effects without any likelihood of benefit. Clinicians are urged to avoid the routine administration of 2 units of RBCs if 1 unit is sufficient and to use appropriate weight-based dosing of RBCs in children.

When less is more? More clear is not possible!

Patient Blood Management program developped by australian blood services contains usefull guidelines for clinicians. Here is the link to these guidelines:

http://www.blood.gov.au/pbm-guidelines

Nice work!

Keep single, is an option! (Western Australia Program)

We must consider the administration of the least dose to obtain the maximun benefit. This benefit will be to correct the signs or symptoms of hypoxia, while specific anemia treatment begins to work.

Actually, at developed countries the most frequent causes of death related with transfusion administration are: clerical errors, ABO hemolytic reactions (mainly due to mistakes), transfusion associated cardiac overload and TRALI.

Message: less volume as possible!

Interesting dilemma. I found a retrospective study by M. Ma at Al (Transf Med, 2015; 15: 307-312) on this topic. In my experience the same behavior is maintained regardless of symptoms. The clinicians often don't take into account the patient's weigth. I created an excel sheet where it is possible to calculate the number of units that have to be transfused to achieve the desired hematocrit, starting from patient's gender, weigth,higth and current Hct. Every day I warn clinicians about the risk of TACO in elderly patients, but the message does not pass easily.

Hi Ivo!

Actually at my hospital we are serving, except in case of active bleeding, the unit one by one. Also, one today and tomorrow "maybe" the second one, after reevaluation!

Also, after review all the "transfusion order" and "hemoglobin level", I try to phone to each prescritor. I had small service presentation in the most important consume service: "treat the patient, not the figure!

Also, in the hemogram study we are treating to add a message like: We recommend the anemia study, or give iron, etc; plus, we recommend the apply of restrictive transfusion criteria: one by one, ajusted to clinical situation and acording cardiovascular risk factors!

We have reduced more than 30%the red cell concentrates in three years. Also we have save more than half millon of euros last years!

But the problem are the own hematologist! My main "enemy" is my own new boss!!

We must fight every day again pre 1988 NIH Conference attitudes!!

I hope to see at Oporto (NATA Meeting)

CADA UNA IMPORTA! (Each one matters)

Based on Spanish Society of Hematology and Hemotherapy´s DO NOT DO Recommendations