Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB
Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB
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DOI：
10.7326/0003-4819-157-1-201206190-00429
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发表时间：
2012-07-03
影响因子：
39.2
通讯作者：
Djulbegovic, Benjamin
中科院分区：
文献类型：
--
作者：
Carson, Jeffrey L.;Grossman, Brenda J.;Djulbegovic, Benjamin
虽然全世界每年约输注8500万单位的红细胞（RBC），但输血实践差异很大。AABB（前身，美国血库协会）制定了这一指南，以提供有关血红蛋白浓度阈值和其他临床变量，触发红细胞输血在血流动力学稳定的成人和childhood.Methods的临床建议：这些指南是基于随机临床试验评估输血阈值的系统评价。我们进行了1950年至2011年2月的文献检索，无语言限制。我们检查了接受任何红细胞输注的患者比例和输注的红细胞单位数，以描述限制性输注策略对红细胞使用的影响。为了确定限制性输血策略的临床后果，我们检查了总体死亡率、非致命性心肌梗死、心脏事件、肺水肿、卒中、血栓栓塞、肾功能衰竭、感染、出血、精神错乱、功能恢复和住院时间。（7 - 8 g/dL），住院稳定患者（等级：强烈建议;高质量证据）。建议2：AABB建议对既存心血管疾病的住院患者坚持限制性策略，对有症状或血红蛋白水平≤ 8 g/dL的患者考虑输血（等级：弱推荐;中等质量证据）。建议3：AABB不能建议或反对对住院、血流动力学稳定的急性冠状动脉综合征患者设定自由或限制性输血阈值（等级：不确定的建议;非常低质量的证据）。建议4：AABB建议输血决定受症状和血红蛋白浓度的影响（等级：弱推荐;低质量的证据）。
Description: Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children.Methods: These guidelines are based on a systematic review of randomized clinical trials evaluating transfusion thresholds. We performed a literature search from 1950 to February 2011 with no language restrictions. We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use. To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay.Recommendation 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence).Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence).Recommendation 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence).Recommendation 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence).