Red Blood Cell Transfusion: 2023 AABB International Guidelines | Critical Care Medicine | JAMA

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Carson" /><meta name="citation_author_institution" content="Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey" /><meta name="citation_author" content="Simon J. 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Raval" /><meta name="citation_author_institution" content="Department of Pathology, University of New Mexico, Albuquerque" /><meta name="citation_author" content="Eric Salazar" /><meta name="citation_author_institution" content="Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas" /><meta name="citation_author" content="Nabiha H. Saifee" /><meta name="citation_author_institution" content="Department of Laboratory Medicine and Pathology, Seattle Children’s Hospital, Seattle, Washington" /><meta name="citation_author" content="Aaron A. R. Tobian" /><meta name="citation_author_institution" content="Department of Pathology, Johns Hopkins University, Baltimore, Maryland" /><meta name="citation_author" content="Cynthia So-Osman" /><meta name="citation_author_institution" content="Department of Unit Transfusion Medicine (UTG), Sanquin Blood Bank, Amsterdam, the Netherlands" /><meta name="citation_author_institution" content="Department Hematology, Erasmus Medical Center, Rotterdam, the Netherlands" /><meta name="citation_author" content="Jonathan Waters" /><meta name="citation_author_institution" content="Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania" /><meta name="citation_author" content="Erica M. Wood" /><meta name="citation_author_institution" content="Department of Haematology, Monash Health, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia" /><meta name="citation_author" content="Nicole D. Zantek" /><meta name="citation_author_institution" content="Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis" /><meta name="citation_author" content="Monica B. Pagano" /><meta name="citation_author_institution" content="Department of Laboratory Medicine and Pathology, University of Washington, Seattle" /><meta name="citation_title" content="Red Blood Cell Transfusion: 2023 AABB International Guidelines" /><meta name="citation_firstpage" content="1892" /><meta name="citation_lastpage" content="1902" /><meta name="citation_doi" content="10.1001/jama.2023.12914" /><meta name="citation_keyword" content="child" /><meta name="citation_keyword" content="erythrocyte transfusion" /><meta name="citation_keyword" content="guidelines" /><meta name="citation_keyword" content="transfusion" /><meta name="citation_keyword" content="transfusion threshold" /><meta name="citation_keyword" content="cardiac surgery procedures" /><meta name="citation_keyword" content="hemoglobin" /><meta name="citation_keyword" content="congenital heart disease" /><meta name="citation_keyword" content="cardiovascular diseases" /><meta name="citation_abstract" content="<h3>Importance</h3><p>Red blood cell transfusion is a common medical intervention with benefits and harms.</p><h3>Objective</h3><p>To provide recommendations for use of red blood cell transfusion in adults and children.</p><h3>Evidence Review</h3><p>Standards for trustworthy guidelines were followed, including using Grading of Recommendations Assessment, Development and Evaluation methods, managing conflicts of interest, and making values and preferences explicit. Evidence from systematic reviews of randomized controlled trials was reviewed.</p><h3>Findings</h3><p>For adults, 45 randomized controlled trials with 20 599 participants compared restrictive hemoglobin-based transfusion thresholds, typically 7 to 8 g/dL, with liberal transfusion thresholds of 9 to 10 g/dL. For pediatric patients, 7 randomized controlled trials with 2730 participants compared a variety of restrictive and liberal transfusion thresholds. For most patient populations, results provided moderate quality evidence that restrictive transfusion thresholds did not adversely affect patient-important outcomes. Recommendation 1: for hospitalized adult patients who are hemodynamically stable, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). In accordance with the restrictive strategy threshold used in most trials, clinicians may choose a threshold of 7.5 g/dL for patients undergoing cardiac surgery and 8 g/dL for those undergoing orthopedic surgery or those with preexisting cardiovascular disease. Recommendation 2: for hospitalized adult patients with hematologic and oncologic disorders, the panel suggests a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (conditional recommendations, low certainty evidence). Recommendation 3: for critically ill children and those at risk of critical illness who are hemodynamically stable and without a hemoglobinopathy, cyanotic cardiac condition, or severe hypoxemia, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). Recommendation 4: for hemodynamically stable children with congenital heart disease, the international panel suggests a transfusion threshold that is based on the cardiac abnormality and stage of surgical repair: 7 g/dL (biventricular repair), 9 g/dL (single-ventricle palliation), or 7 to 9 g/dL (uncorrected congenital heart disease) (conditional recommendation, low certainty evidence).</p><h3>Conclusions and Relevance</h3><p>It is good practice to consider overall clinical context and alternative therapies to transfusion when making transfusion decisions about an individual patient.</p>" /><meta name="citation_journal_title" content="JAMA" /><meta name="citation_journal_abbrev" content="JAMA" /><meta name="citation_volume" content="330" /><meta name="citation_issue" content="19" /><meta name="citation_publication_date" content="2023/11/21" /><meta name="citation_issn" content="0098-7484" /><meta name="citation_publisher" content="American Medical Association" /><meta name="citation_reference" content="World Health Organization. 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data-value="Jeffrey%20L.%C2%A0Carson%2C%C2%A0MD,Simon%20J.%C2%A0Stanworth%2C%C2%A0MD%2C%20DPhil,Gordon%C2%A0Guyatt%2C%C2%A0MD,Stacey%C2%A0Valentine%2C%C2%A0MD%2C%20MPH,Jane%C2%A0Dennis%2C%C2%A0PhD,Sara%C2%A0Bakhtary%2C%C2%A0MD,Claudia%20S.%C2%A0Cohn%2C%C2%A0MD%2C%20PhD,Allan%C2%A0Dubon%2C%C2%A0MLS,Brenda%20J.%C2%A0Grossman%2C%C2%A0MD%2C%20MPH,Gaurav%20K.%C2%A0Gupta%2C%C2%A0MD%2C%20PhD,Aaron%20S.%C2%A0Hess%2C%C2%A0MD%2C%20PhD,Jessica%20L.%C2%A0Jacobson%2C%C2%A0MD,Lewis%20J.%C2%A0Kaplan%2C%C2%A0MD,Yulia%C2%A0Lin%2C%C2%A0MD,Ryan%20A.%C2%A0Metcalf%2C%C2%A0MD,Colin%20H.%C2%A0Murphy%2C%C2%A0MD,Katerina%C2%A0Pavenski%2C%C2%A0MD,Micah%20T.%C2%A0Prochaska%2C%C2%A0MD,Jay%20S.%C2%A0Raval%2C%C2%A0MD,Eric%C2%A0Salazar%2C%C2%A0MD%2C%20PhD,Nabiha%20H.%C2%A0Saifee%2C%C2%A0MD%2C%20PhD,Aaron%20A.%20R.%C2%A0Tobian%2C%C2%A0MD%2C%20PhD,Cynthia%C2%A0So-Osman%2C%C2%A0MD%2C%20PhD,Jonathan%C2%A0Waters%2C%C2%A0MD,Erica%20M.%C2%A0Wood%2C%C2%A0MD,Nicole%20D.%C2%A0Zantek%2C%C2%A0MD%2C%20PhD,Monica%20B.%C2%A0Pagano%2C%C2%A0MD" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="articleDOI" data-value="10.1001/jama.2023.12914" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articleTitle" data-value="Red Blood Cell Transfusion<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>2023 AABB International Guidelines</span>" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="type" data-value="Special Communication" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueVolume" data-value="330" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="issueNo" data-value="19" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="publishDate" data-value="November 21, 2023" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="topics" data-value="Critical Care Medicine, Emergency Medicine, Guidelines, Hematology, Surgery, Bleeding and Transfusion, Pathology and Laboratory Medicine" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="topicCode" data-value="5584, 5621, 5672, 5688, 5923, 42099, 44029" data-type="array"></span> <span class="hide tagmanagervalue" data-attribute="category" data-value="Review" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="journalClub" data-value="No" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentStatus" data-value="Locked" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="articlePubState" data-value="Final" data-type="string"></span> <span class="hide tagmanagervalue" data-attribute="contentMedium" data-value="Article" data-type="string"></span> <div class="meta-article-type-wrap"> <div class="meta-article-type thm-col">Special Communication </div> </div> <div class="meta-date">October 12, 2023</div> <div class="meta-article-title-wrap"> <h1 class="meta-article-title ">Red Blood Cell Transfusion<span class="subtitle"><span class="colon-for-citation-subtitle">: </span>2023 AABB International Guidelines</span></h1> </div> <div class="meta-authors"> <span class="meta-authors--limited"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jeffrey+L.+Carson&q=Jeffrey+L.+Carson" rel=nofollow target="_blank">Jeffrey L. Carson, MD<sup>1</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Simon+J.+Stanworth&q=Simon+J.+Stanworth" rel=nofollow target="_blank">Simon J. Stanworth, MD, DPhil<sup>2,3,4,5</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Gordon+Guyatt&q=Gordon+Guyatt" rel=nofollow target="_blank">Gordon Guyatt, MD<sup>6</sup></a></span>; <a class="meta-authors--etal td-u stats-meta-authors--etal">et al</a></span> <span class="meta-authors--remaining"><span class="wi-fullname brand-fg"><a href="/searchresults?author=Stacey+Valentine&q=Stacey+Valentine" rel=nofollow target="_blank">Stacey Valentine, MD, MPH<sup>7</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jane+Dennis&q=Jane+Dennis" rel=nofollow target="_blank">Jane Dennis, PhD<sup>8</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Sara+Bakhtary&q=Sara+Bakhtary" rel=nofollow target="_blank">Sara Bakhtary, MD<sup>9</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Claudia+S.+Cohn&q=Claudia+S.+Cohn" rel=nofollow target="_blank">Claudia S. Cohn, MD, PhD<sup>10</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Allan+Dubon&q=Allan+Dubon" rel=nofollow target="_blank">Allan Dubon, MLS<sup>11</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Brenda+J.+Grossman&q=Brenda+J.+Grossman" rel=nofollow target="_blank">Brenda J. Grossman, MD, MPH<sup>12</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Gaurav+K.+Gupta&q=Gaurav+K.+Gupta" rel=nofollow target="_blank">Gaurav K. Gupta, MD, PhD<sup>13</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Aaron+S.+Hess&q=Aaron+S.+Hess" rel=nofollow target="_blank">Aaron S. Hess, MD, PhD<sup>14</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jessica+L.+Jacobson&q=Jessica+L.+Jacobson" rel=nofollow target="_blank">Jessica L. Jacobson, MD<sup>15,16</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Lewis+J.+Kaplan&q=Lewis+J.+Kaplan" rel=nofollow target="_blank">Lewis J. Kaplan, MD<sup>17</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Yulia+Lin&q=Yulia+Lin" rel=nofollow target="_blank">Yulia Lin, MD<sup>18</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Ryan+A.+Metcalf&q=Ryan+A.+Metcalf" rel=nofollow target="_blank">Ryan A. Metcalf, MD<sup>19</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Colin+H.+Murphy&q=Colin+H.+Murphy" rel=nofollow target="_blank">Colin H. Murphy, MD<sup>20</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Katerina+Pavenski&q=Katerina+Pavenski" rel=nofollow target="_blank">Katerina Pavenski, MD<sup>21</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Micah+T.+Prochaska&q=Micah+T.+Prochaska" rel=nofollow target="_blank">Micah T. Prochaska, MD<sup>22</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jay+S.+Raval&q=Jay+S.+Raval" rel=nofollow target="_blank">Jay S. Raval, MD<sup>23</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Eric+Salazar&q=Eric+Salazar" rel=nofollow target="_blank">Eric Salazar, MD, PhD<sup>24</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Nabiha+H.+Saifee&q=Nabiha+H.+Saifee" rel=nofollow target="_blank">Nabiha H. Saifee, MD, PhD<sup>25</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Aaron+A.+R.+Tobian&q=Aaron+A.+R.+Tobian" rel=nofollow target="_blank">Aaron A. R. Tobian, MD, PhD<sup>26</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Cynthia+So-Osman&q=Cynthia+So-Osman" rel=nofollow target="_blank">Cynthia So-Osman, MD, PhD<sup>27,28</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Jonathan+Waters&q=Jonathan+Waters" rel=nofollow target="_blank">Jonathan Waters, MD<sup>29</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Erica+M.+Wood&q=Erica+M.+Wood" rel=nofollow target="_blank">Erica M. Wood, MD<sup>30</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Nicole+D.+Zantek&q=Nicole+D.+Zantek" rel=nofollow target="_blank">Nicole D. Zantek, MD, PhD<sup>31</sup></a></span><span class='al-author-delim'>; </span><span class="wi-fullname brand-fg"><a href="/searchresults?author=Monica+B.+Pagano&q=Monica+B.+Pagano" rel=nofollow target="_blank">Monica B. Pagano, MD<sup>32</sup></a></span></span> </div> <div class="meta-author"> <a class="meta-author-title is-b stats-meta-author-toggle" data-tog-target=".meta-author-content">Author Affiliations</a> <a class="meta-articleinfo-jumplink section-jump-link scroll-to stats-scroll-to-articleinfo" data-tab-toggle=".tab-nav-full-text" href="#249351300">Article Information</a> <div class="meta-author-content"> <ul class="meta-author-affiliations"> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>1</sup>Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>2</sup>Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>3</sup>NHSBT, Oxford, United Kingdom</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>4</sup>Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>5</sup>Department of Transfusion Medicine, NHS Blood and Transplant, Oxford, United Kingdom</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>6</sup>Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>7</sup>Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>8</sup>Cochrane Injuries Group, London School of Hygiene and Tropical Medicine, London, United Kingdom</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>9</sup>Department of Laboratory Medicine, University of California, San Francisco</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>10</sup>Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>11</sup>Patient partner</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>12</sup>Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>13</sup>Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>14</sup>Departments of Anesthesiology and Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>15</sup>Department of Pathology, New York University Grossman School of Medicine, New York</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>16</sup>NYC Health + Hospitals/Bellevue, New York, New York</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>17</sup>Department of Surgery, Division of Trauma, Surgical Critical Care and Surgical Emergencies, Perelman School of Medicine, University of Pennsylvania, Philadelphia</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>18</sup>Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>19</sup>Department of Pathology, University of Utah, Salt Lake City</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>20</sup>Pathology Associates of Albuquerque, Albuquerque, New Mexico</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>21</sup>Department of Laboratory Medicine and Pathobiology, University of Toronto and St Michael’s Hospital–Unity Health Toronto, Toronto, Ontario, Canada</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>22</sup>Department of Medicine, University of Chicago, Chicago, Illinois</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>23</sup>Department of Pathology, University of New Mexico, Albuquerque</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>24</sup>Department of Pathology and Laboratory Medicine, UT Health San Antonio, San Antonio, Texas</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>25</sup>Department of Laboratory Medicine and Pathology, Seattle Children’s Hospital, Seattle, Washington</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>26</sup>Department of Pathology, Johns Hopkins University, Baltimore, Maryland</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>27</sup>Department of Unit Transfusion Medicine (UTG), Sanquin Blood Bank, Amsterdam, the Netherlands</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>28</sup>Department Hematology, Erasmus Medical Center, Rotterdam, the Netherlands</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>29</sup>Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>30</sup>Department of Haematology, Monash Health, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>31</sup>Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis</div> </li> <li class="meta-author-affiliation"> <div class="meta-author-name"><sup>32</sup>Department of Laboratory Medicine and Pathology, University of Washington, Seattle</div> </li> </ul> </div> </div> <div class="meta-citation-wrap"> <span class="meta-citation-journal-name">JAMA. </span><span class="meta-citation"> 2023;330(19):1892-1902. doi:10.1001/jama.2023.12914</span> </div> </div> <div class="widget-EditorsChoice widget-instance-AMA_EditorsChoice_Links"> </div> <div class="widget-LinkedContentToolbar widget-instance-AMA_LinkedContentToolbar"> <div class="linked-content-toolbar"> <div class="hidden js-search-open-multimedia-by-default" showContentByDefault="False"></div> <div class="linked-content-controls"> <a class="linked-content-trigger td-n stats-graphical-abstract" href="#graphical-abstract-tab"> <i 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href="https://jamanetwork.com/journals/jama/fullarticle/2812058"> <div class="related-article-type">Editorial</div> <div class="related-article-title sb-tc">Blood, Bleeding, and Transfusion—A Theme Issue</div> </a> <div class="related-article-authors">Christopher W. Seymour, MD, MSc</div> <div class="related-article-journal-name">JAMA</div> </li> </ul> </div> </div> <div id="related-articles-tab" class="linked-content-tab related-article-tab"> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedArticle"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-title" href="https://jamanetwork.com/journals/jama/fullarticle/2810753"> <div class="related-article-type">Viewpoint</div> <div class="related-article-title sb-tc">Transfusion and Patient Blood Management</div> </a> <div class="related-article-authors">Matthew A. Warner, MD; Linda Shore-Lesserson, MD; Carolyn Burns, MD</div> <div class="related-article-journal-name">JAMA</div> </li> </ul> </div> <div class="widget-ArticleLinks widget-instance-AMA_LinkedContentToolbar_RelatedEditorsChoices"> </div> </div> <div id="author-interviews-tab" class="linked-content-tab linked-author-interviews-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_AuthorInterviews"> </div> </div> <div id="listen-to-this-article-tab" class="linked-content-tab linked-listen-to-this-article-tab"> <div class="widget-AudioPlayer widget-instance-AMA_LinkedContentToolbar_PlatformAudioPlayer_ListenToThisArticle"> </div> </div> <div id="more-multimedia-tab" class="linked-content-tab more-multimedia-tab"> </div> </div> </div> </div> <a class="full-text-link is-b" data-url="" data-article-id="2810754"> <div class="full-text-link--text"><span class="full-text-link--text-top">Full </span>Text</div> </a> <div class="abstract-content"> <div class="widget-ArticleFulltext widget-instance-AMA_Article_Abstract_Widget"> <div class="article-full-text" data-userHasAccess="False"> <a class="article-section-id-anchor" id="249351219"></a> <div class="h3 cb section-type-abstract decorated-hed "> <div class="heading-text thm-col sb-sc"> Abstract </div> </div> <p><strong>Importance</strong> <span>Red blood cell transfusion is a common medical intervention with benefits and harms.</span></p><p><strong>Objective</strong> <span>To provide recommendations for use of red blood cell transfusion in adults and children.</span></p><p><strong>Evidence Review</strong> <span>Standards for trustworthy guidelines were followed, including using Grading of Recommendations Assessment, Development and Evaluation methods, managing conflicts of interest, and making values and preferences explicit. Evidence from systematic reviews of randomized controlled trials was reviewed.</span></p><p><strong>Findings</strong> <span>For adults, 45 randomized controlled trials with 20 599 participants compared restrictive hemoglobin-based transfusion thresholds, typically 7 to 8 g/dL, with liberal transfusion thresholds of 9 to 10 g/dL. For pediatric patients, 7 randomized controlled trials with 2730 participants compared a variety of restrictive and liberal transfusion thresholds. For most patient populations, results provided moderate quality evidence that restrictive transfusion thresholds did not adversely affect patient-important outcomes. Recommendation 1: for hospitalized adult patients who are hemodynamically stable, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). In accordance with the restrictive strategy threshold used in most trials, clinicians may choose a threshold of 7.5 g/dL for patients undergoing cardiac surgery and 8 g/dL for those undergoing orthopedic surgery or those with preexisting cardiovascular disease. Recommendation 2: for hospitalized adult patients with hematologic and oncologic disorders, the panel suggests a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (conditional recommendations, low certainty evidence). Recommendation 3: for critically ill children and those at risk of critical illness who are hemodynamically stable and without a hemoglobinopathy, cyanotic cardiac condition, or severe hypoxemia, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). Recommendation 4: for hemodynamically stable children with congenital heart disease, the international panel suggests a transfusion threshold that is based on the cardiac abnormality and stage of surgical repair: 7 g/dL (biventricular repair), 9 g/dL (single-ventricle palliation), or 7 to 9 g/dL (uncorrected congenital heart disease) (conditional recommendation, low certainty evidence).</span></p><p><strong>Conclusions and Relevance</strong> <span>It is good practice to consider overall clinical context and alternative therapies to transfusion when making transfusion decisions about an individual patient.</span></p> <div class="movable-ad-target bta"> </div> </div> </div> <div class="widget-ArticleLinks widget-instance-AMA_Abstract_EditorialComments"> <ul class="article-abstract-links related-abstract-content"> <li class="article-link related-abstract-article"> <a class="related-article-abstract-link" href="https://jamanetwork.com/journals/jama/fullarticle/2812058"> <div 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