transfusion goals

TRICC and POCUS

  • transfusion goal of 7 for stable patients in hospital
  • transfusion goal of 8 or if symptoms for preexisting CV disease patients and in postoperative patients
  • no transfusion goal for patients with ACS

TRICC Trial

  • subgroup analysis showed pts with cardiovascular disease have increased mortality with restrictive transfusion

FOCUS trial

  • transfuse goal 8 or if symptomatic

  • symptoms defined as orthostatic hypotension, tachycardia unresponsive to fluid challenge, chest pain, CHF

  • withholding transfusion for patients with symptoms could lead to increased adverse events

  • GI bleed

  • inclusion: over 18, hx of upper GI bleed

  • exclusion: lower GI bleed, TIA, recent trauma/surgery, ACS, massive bleeding.

A hemoglobin level >8 g/dL is recommended in patients with stable coronary artery disease or in those planning to undergo major surgery (eg, certain orthopedic procedures). Patients with acute coronary syndrome, severe thrombocytopenia, or cancer with a high bleeding risk may require a higher transfusion goal. Those with massive bleeding and hemodynamic instability might require blood transfusion regardless of hemoglobin levels, as initial levels may not accurately reflect the amount of blood loss (Choice D).