New ‘PBM Column’ Explores Updates in RBC Transfusion Guidelines

AABB’s Transfusion Safety and Patient Blood Management (TS/PBM) Subsection recently released the latest article in its “PBM Column” series, “Updates in Red Blood Cell Transfusion Thresholds.” Authored by Richard Gammon, MD, medical director at OneBlood, the column offers insights into recent advancements in red blood cell transfusion guidelines based on randomized controlled trials and international recommendations.

Gammon begins with an overview of the recommendations outlined in the 2023 AABB International Guidelines for Red Blood Cell Transfusion, published in JAMA in October. These guidelines advocate for a restrictive approach to transfusions in hospitalized adult patients who are hemodynamically stable, recommending that clinicians consider transfusion when the hemoglobin concentration falls below 7 g/dL. Gammon also discusses specific recommendations for hospitalized adult patients with hematologic and oncologic disorders and describes the evidence that informed these guidelines.

Next, the column highlights the guidelines’ nuanced approach for pediatric patients, particularly those who are critically ill or have congenital heart disease. The pediatric transfusion guidelines emphasize tailored hemoglobin thresholds aimed at optimizing oxygen delivery while minimizing transfusion-associated risks.

Gammon also discusses findings from the Myocardial Ischemia and Transfusion (MINT) study, which investigated transfusion strategies among patients with acute myocardial infarction and anemia. The study's results suggest that while a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or mortality at 30 days, it demonstrated favorable outcomes in point estimates across various clinical endpoints. Gammon noted that further research is necessary to validate these findings and determine the optimal transfusion strategy for patients with acute myocardial infarction and anemia.

Additional PBM resources are available in AABB’s PBM Toolkit.