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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.

Original publication

DOI

10.1016/S0140-6736(13)60650-9

Type

Journal article

Journal

Lancet

Publication Date

25/05/2013

Volume

381

Pages

1845 - 1854

Keywords

Adult, Blood Transfusion, Cardiovascular Diseases, Erythrocyte Transfusion, Evidence-Based Medicine, Guideline Adherence, Hemoglobins, Humans, Postoperative Complications, Practice Guidelines as Topic, Professional Practice, Randomized Controlled Trials as Topic