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

The Cochrane Library
Paul A Carless, David A Henry, Jeffrey L Carson, Paul PC Hebert, Brian McClelland, Katharine Ker
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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 for 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 the Cochrane Central Register of Controlled Trials (the Cochrane Library Issue 3, 2009),
OVID MEDLINE (1966 to August 2009), Current Contents (1993 to November 2004), and the Web of Science (2004 to August
2009). References in identified trials and review articles were checked and experts contacted to identify any additional trials.
Selection criteria
Controlled trials in which patients were randomised to an intervention group or to a control group. Trials were included where
intervention groups were assigned on the basis of a clear transfusion ’trigger’, described as a haemoglobin (Hb) or haematocrit (Hct)
level below which an RBC transfusion was to be administered.
Data collection and analysis
Relative risks of requiring allogeneic blood transfusion, transfused blood volumes and other clinical outcomes were pooled across trials,
using a random effects model. The risk of bias was assessed.