Reducing the frequency of red blood cell transfusion is a goal of modern
blood management. The primary driving force during the past 15 years has been
safety. In the mid 1980s the HIV (human immunodeficiency virus) epidemic and
frequent transmission of hepatitis C led to careful examination of transfusion
practices.1 A review of the data available
then showed no evidence for maintaining hemoglobin concentrations at 10 g/dL
or hematocrit at 30%,1 the so-called 10/30
rule. Subsequent new guidelines urged a lower threshold and consideration
of symptoms and other clinical parameters,2 although
clinical judgment was the cornerstone of many of the recommendations.
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