Monday, February 15, 2010

New guidelines for RBC transfusion

---have been released by a joint task force of EAST (Eastern Association for Surgery of Trauma) and the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM). The guidelines target critical illness in a variety of settings.

Guideline article in Critical Care Medicine.

PDF of the full document.

Medscape commentary.

A few points of interest:

This is a more conservative strategy than we've been used to. A threshold of a Hgb of 7 is recommended for almost all hemodynamically stable situations except for acute coronary syndromes in which a threshold of 8 is suggested.

Although the recommendation summary says “RBC transfusion should not be considered as an absolute method to improve tissue oxygen consumption in critically ill patients” it is acknowledged in the body of the document that a Hct target of 10 in patients with septic shock may be applicable according to the EGDT protocol during the first 6 hours of treatment.

The document notes the risks of acute infection, SIRS, MOFS and TRALI associated with transfusion and comments on the underappreciated nature of TRALI as well as the need for diagnostic efforts and reporting when the condition is suspected.

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