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JAMA Clinical Evidence Synopsis | Clinician's Corner

Outcomes Using Lower vs Higher Hemoglobin Thresholds for Red Blood Cell Transfusion

Jeffrey L. Carson, MD; Paul A. Carless, MMedSc (Clin Epid); Paul C. Hébert, MD, MSc
JAMA. 2013;309(1):83-84. doi:10.1001/jama.2012.50429.
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Clinical Question: Is a lower vs higher hemoglobin threshold best for minimizing both red blood cell use and adverse clinical outcomes when used to trigger red blood cell transfusions in anemic patients in critical care and acute care settings?

Bottom Line: Compared with higher hemoglobin thresholds, a hemoglobin threshold of 7 or 8 g/dL is associated with fewer red blood cell units transfused without adverse associations with mortality, cardiac morbidity, functional recovery, or length of hospital stay.

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Figure. Association of a Higher vs Lower Hemoglobin Threshold on 30-Day Mortality in Patients With Anemia
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30-Day mortality was evaluated in 4975 patients included in 11 of 19 trials. Adapted from Analysis 3.2 in Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012;4:CD002042. doi: 10.1002/14651858.CD002042.pub3

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