Reducing unnecessary red blood cell transfusion in hospitalised patients

Transfusion of red blood cells (RBC) is used to treat patients with severe anaemia or bleeding. Supplies of blood for transfusion need to be protected, as countries have experienced a decline in donation rates during the covid-19 pandemic.1 However, published international audits describe inappropriate rates of RBC transfusion of 22-57% in a variety of clinical settings, including hospitalised inpatients, operative units, and emergency departments.234 Unnecessary blood transfusions may expose patients to harms, including allergic, febrile, or haemolytic reactions; circulatory overload associated with transfusion (seen in up to 1-6% of transfused patients); and acute lung injury.5 These complications may occur without the transfusion adding any clinical benefit. Blood products are costly to collect and administer. Their overuse wastes a limited precious resource donated by the public.6

Conservative blood use, often referred to as “restrictive transfusion practice,” is recommended in stable, non-bleeding patients by the National Institute for Health and Care Excellence (NICE) and the Choosing Wisely campaigns in Canada, the UK, and the US.78910 Recommendations focus on two major clinical decision points: the haemoglobin concentration (Hb) at which blood transfusion is considered, and the number of RBC units administered at a time (table 1).