12/7/2014 www.medscape.

com/viewarticle/833225_print

www.medscape.com

NewStandardforTransfusionThreshold?
AlbertB.Lowenfels,MD October21,2014

LowerVersusHigherHemoglobinThresholdforTransfusioninSepticShock
HolstLB,HaaseN,WetterslevJ,etal

NEnglJMed.2014371:13811391

StudySummary

Incriticallyillpatients,isthemortalityrateafteruseofalowertransfusionthreshold(7g/dL)differentfromthatfound
whenahighertransfusionthreshold(9g/dL)isused?Holstandcolleaguesperformedarandomizedtrialinvolving998
septicintensivecarepatientsmortalityat3monthswasthespecifiedendpoint.Themortalityratesweresimilar:
43%ofthepatientsinthelowerthresholdgroupdied,comparedwith45%ofpatientsinthehigherthresholdgroup(P
=.44).Therewasahighlysignificantdifferenceintransfusionrequirements:3088unitsinthehightransfusionlevel
groupcomparedwith1545unitsinthelowtransfusionlevelgroup.(P<.001).

Viewpoint

Inthisrandomizedtrial,mortalityratesweresimilarincriticallyillpatientswhenthetransfusionlevelwassetat
hemoglobinlevelsofeither7or9g/dL.Notonlywasthelowerthresholdlevelsafe,butithalvedtheamountofblood
transfused.TheresultsofthisreportagreewiththoseofapreviousCochranereview[1]andaresimilartoresults
basedonpatientswithgastrointestinalhemorrhage. [2]Theaccompanyingeditorial[3]recommendsahemoglobinlevel
of7g/dLasthenewstandard.

Abstract

References

1. CarsonJL,CarlessPA,HebertPC.Transfusionthresholdsandotherstrategiesforguidingallogeneicred
bloodcelltransfusion.CochraneDatabaseSystRev.20124:CD002042.

2. VillanuevaC,ColomoA,BoschA,etal.Transfusionstrategiesforacuteuppergastrointestinalbleeding.N
EnglJMed.2013368:1121.Abstract

3. HbertPC,CarsonJL.Transfusionthresholdof7gperdeciliterthenewnormal.NEnglJMed.
2014371:14591461.Abstract

MedscapeGeneralSurgery2014WebMD,LLC

Citethisarticle:AlbertB.Lowenfels.NewStandardforTransfusionThreshold?Medscape.Oct21,2014.

http://www.medscape.com/viewarticle/833225_print 1/1