Key Takeaways

RBC transfusion is indicated for symptomatic deficiency of O2-carrying capacity or tissue hypoxia due to anemia if the Hb level is below 7 g/dL in hospitalized adult patients who are hemodynamically stable, including critically ill patients. A higher Hb threshold of 8 g/dL is recommended for patients with preexisting cardiovascular disease, undergoing orthopedic or cardiac surgery.

Monitor the response to RBC transfusion clinically and by post-transfusion Hb/Hct levels. One RBC unit should increase Hb by 1 g/dL or Hct by 3% in adult patients. The lack of appropriate response might indicate hyperhemolysis, a potentially fatal condition which occurs in sickle cell disease but has been described in other hematological disorders.

RBC transfusion is not indicated for acute blood loss <20-30% blood volume, nutritional anemias or as a substitute for iron or B12 supplements, to increase colloid osmotic pressure as a volume expander, improve wound healing or enhance a patient’s subjective sense of well-being, and almost never for a Hb ≥ 10 g/dL.

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