Hemodynamics, fluids & transfusion
Red Blood Cell Transfusion: 2023 AABB International Guidelines
Methodological detailsGRADE methods, Evidence from systematic reviews of RCTs: adults 45 RCTs (20 599 participants), restrictive (typically 7 to 8 g/dL) vs liberal (9 to 10 g/dL) thresholds; children 7 RCTs (2730 participants)
- GRADE methods
- Evidence from systematic reviews of RCTs: adults 45 RCTs (20 599 participants), restrictive (typically 7 to 8 g/dL) vs liberal (9 to 10 g/dL) thresholds; children 7 RCTs (2730 participants)
Recommendations
As issued by the authors
- strong recommendation, moderate certainty evidence
Hospitalized hemodynamically stable adults: restrictive strategy, considering transfusion when hemoglobin is less than 7 g/dL; clinicians may choose 7.5 g/dL for cardiac surgery and 8 g/dL for orthopedic surgery or preexisting CVD
- conditional recommendations, low certainty evidence
Hospitalized adults with hematologic and oncologic disorders: restrictive strategy, considering transfusion when hemoglobin is less than 7 g/dL
- strong recommendation, moderate certainty evidence
Hemodynamically stable critically ill children and those at risk of critical illness, without hemoglobinopathy, cyanotic cardiac condition or severe hypoxemia: restrictive strategy, considering transfusion when hemoglobin is less than 7 g/dL
- conditional recommendation, low certainty evidence
Hemodynamically stable children with congenital heart disease: threshold based on cardiac abnormality and stage of repair: 7 g/dL (biventricular repair), 9 g/dL (single-ventricle palliation), or 7 to 9 g/dL (uncorrected congenital heart disease)
Original publication
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