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Lancet. 2013 May 25;381(9880):1845-54. doi: 10.1016/S0140-6736(13)60650-9.

Concepts of blood transfusion in adults.

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1
Department of Pathology, Stanford University, Stanford, CA, USA. ltgoodno@stanford.edu

Abstract

Recent progress has been made in the identification and implementation of best transfusion practices on the basis of evidence-based clinical trials, published clinical practice guidelines, and process improvements for blood use and clinical patient outcomes. However, substantial variability persists in transfusion outcomes for patients in some clinical settings--eg, patients undergoing cardiothoracic surgery. This variability could be the result of insufficient understanding of published guidelines; different recommendations of medical societies, including the specification of a haemoglobin concentration threshold to use as a transfusion trigger; the value of haemoglobin as a surrogate indicator for transfusion benefit, even though only changes in concentration and not absolute red cell mass of haemoglobin can be identified; and disagreement about the validity of the level 1 evidence for clinical practice guidelines. Nevertheless, institutional experience and national databases suggest that a restrictive blood transfusion approach is being increasingly implemented as best practice.

PMID:
23706801
DOI:
10.1016/S0140-6736(13)60650-9
[Indexed for MEDLINE]
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