Transfusion thresholds and other strategies for guidingallogeneic red blood cell transfusion

Cochrane Database
Jeffrey L Carson1, Paul A Carless2, Paul C Hebert3
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Background
Most clinical practice guidelines recommend restrictive red cell transfusion practices, with the goal of minimising exposure to allogeneic
blood. 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 red cell transfusion, and the
evidence for any effect on clinical outcomes.
Search methods
We identified trials by searching: the Cochrane Injuries Group Specialised Register (searched 1 February 2011), the Cochrane Central
Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE (Ovid) 1948 to January Week 3 2011,
EMBASE (Ovid) 1980 to 2011 (Week 04), ISIWeb of Science: Science Citation Index Expanded (1970 to February 2011) and ISIWeb
of Science: Conference Proceedings Citation Index – Science (1990 to February 2011). We checked reference lists of other published
reviews and relevant papers to identify any additional trials.
Selection criteria
Controlled trials inwhich patientswere randomised to an intervention group or to a control group.We included trialswhere intervention
groups were assigned on the basis of a clear transfusion ’trigger’, described as a haemoglobin (Hb) or haematocrit (Hct) level below
which a red blood cell (RBC) transfusion was to be administered.
Data collection and analysis
We pooled risk ratios of requiring allogeneic blood transfusion, transfused blood volumes and other clinical outcomes across trials using
a random-effects model. Two people performed data extraction and assessment of the risk of bias.