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Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion.

Abstract

BACKGROUND

Most clinical practice guidelines recommend restrictive red cell transfusion practices with the goal of minimising exposure to allogeneic blood (from an unrelated donor). The purpose of this review is to compare clinical outcomes in patients randomised to restrictive versus liberal transfusion thresholds (triggers).

OBJECTIVES

To examine the evidence on the effect of transfusion thresholds, on the use of allogeneic and/or autologous blood, and the evidence for any effect on clinical outcomes.

SEARCH STRATEGY

Trials were identified by: computer searches of OVID Medline (1966 to December 2000), Current Contents (1993 to Week 48 2000), and the Cochrane Controlled Trials Register (2000 Issue 4). References in identified trials and review articles were checked and authors contacted to identify any additional studies.

SELECTION CRITERIA

Controlled trials in which patients were randomised to an intervention group or to a control group. Trials were included where the intervention groups were assigned on the basis of a clear transfusion "trigger", described as a haemoglobin (Hb) or haematocrit (Hct) level below which a RBC transfusion was to be administered.

DATA COLLECTION AND ANALYSIS

Trial quality was assessed using criteria proposed by Schulz et al. (1995). Relative risks of requiring allogeneic blood transfusion, transfused blood volumes and other clinical outcomes were pooled across trials using a random effects model.

MAIN RESULTS

Ten trials were identified that reported outcomes for a total of 1780 patients. Restrictive transfusion strategies reduced the risk of receiving a red blood cell (RBC) transfusion by a relative 42% (RR=0.58: 95%CI=0.47,0.71). This equates to an average absolute risk reduction (ARR) of 40% (95%CI=24% to 56%). The volume of RBCs transfused was reduced on average by 0.93 units (95%CI=0.36,1.5 units). However, heterogeneity between these trials was statistically significant (p<0.00001) for these outcomes. Mortality, rates of cardiac events, morbidity, and length of hospital stay were unaffected. Trials were of poor methodological quality.

REVIEWER'S CONCLUSIONS

The limited published evidence supports the use of restrictive transfusion triggers in patients who are free of serious cardiac disease. However, most of the data on clinical outcomes were generated by a single trial. The effects of conservative transfusion triggers on functional status, morbidity and mortality, particularly in patients with cardiac disease, need to be tested in further large clinical trials. In countries with inadequate screening of donor blood the data may constitute a stronger basis for avoiding transfusion with allogeneic red cells.

Authors+Show Affiliations

Clinical Pharmacology, University of Newcastle, Level 5 Clinical Sciences Building Newcastle Mater Hospital, Edith Street, Newcastle, New South Wales, Australia, 2298. hillsu@mail.newcastle.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

12076437

Citation

Hill, S R., et al. "Transfusion Thresholds and Other Strategies for Guiding Allogeneic Red Blood Cell Transfusion." The Cochrane Database of Systematic Reviews, 2002, p. CD002042.
Hill SR, Carless PA, Henry DA, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2002.
Hill, S. R., Carless, P. A., Henry, D. A., Carson, J. L., Hebert, P. C., McClelland, D. B., & Henderson, K. M. (2002). Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. The Cochrane Database of Systematic Reviews, (2), CD002042.
Hill SR, et al. Transfusion Thresholds and Other Strategies for Guiding Allogeneic Red Blood Cell Transfusion. Cochrane Database Syst Rev. 2002;(2)CD002042. PubMed PMID: 12076437.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. AU - Hill,S R, AU - Carless,P A, AU - Henry,D A, AU - Carson,J L, AU - Hebert,P C, AU - McClelland,D B, AU - Henderson,K M, PY - 2002/6/22/pubmed PY - 2002/8/10/medline PY - 2002/6/22/entrez SP - CD002042 EP - CD002042 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Most clinical practice guidelines recommend restrictive red cell transfusion practices with the goal of minimising exposure to allogeneic blood (from an unrelated donor). The purpose of this review is to compare clinical outcomes in patients randomised to restrictive versus liberal transfusion thresholds (triggers). OBJECTIVES: To examine the evidence on the effect of transfusion thresholds, on the use of allogeneic and/or autologous blood, and the evidence for any effect on clinical outcomes. SEARCH STRATEGY: Trials were identified by: computer searches of OVID Medline (1966 to December 2000), Current Contents (1993 to Week 48 2000), and the Cochrane Controlled Trials Register (2000 Issue 4). References in identified trials and review articles were checked and authors contacted to identify any additional studies. SELECTION CRITERIA: Controlled trials in which patients were randomised to an intervention group or to a control group. Trials were included where the intervention groups were assigned on the basis of a clear transfusion "trigger", described as a haemoglobin (Hb) or haematocrit (Hct) level below which a RBC transfusion was to be administered. DATA COLLECTION AND ANALYSIS: Trial quality was assessed using criteria proposed by Schulz et al. (1995). Relative risks of requiring allogeneic blood transfusion, transfused blood volumes and other clinical outcomes were pooled across trials using a random effects model. MAIN RESULTS: Ten trials were identified that reported outcomes for a total of 1780 patients. Restrictive transfusion strategies reduced the risk of receiving a red blood cell (RBC) transfusion by a relative 42% (RR=0.58: 95%CI=0.47,0.71). This equates to an average absolute risk reduction (ARR) of 40% (95%CI=24% to 56%). The volume of RBCs transfused was reduced on average by 0.93 units (95%CI=0.36,1.5 units). However, heterogeneity between these trials was statistically significant (p<0.00001) for these outcomes. Mortality, rates of cardiac events, morbidity, and length of hospital stay were unaffected. Trials were of poor methodological quality. REVIEWER'S CONCLUSIONS: The limited published evidence supports the use of restrictive transfusion triggers in patients who are free of serious cardiac disease. However, most of the data on clinical outcomes were generated by a single trial. The effects of conservative transfusion triggers on functional status, morbidity and mortality, particularly in patients with cardiac disease, need to be tested in further large clinical trials. In countries with inadequate screening of donor blood the data may constitute a stronger basis for avoiding transfusion with allogeneic red cells. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/12076437/Transfusion_thresholds_and_other_strategies_for_guiding_allogeneic_red_blood_cell_transfusion_ L2 - https://doi.org/10.1002/14651858.CD002042 DB - PRIME DP - Unbound Medicine ER -