Society of Hospital Medicine – Adult Hospital Medicine

View all recommendations from this society

Released February 21, 2013

Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of active coronary disease, heart failure or stroke.

The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients. The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration. According to a National Institutes of Health Consensus Conference, no single criterion should be used as an indication for red cell component therapy. Instead, multiple factors related to the patient’s clinical status and oxygen delivery should be considered.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Society of Hospital Medicine (SHM) created a Choosing Wisely® subcommittee comprised of representatives of the Hospital Quality and Patient Safety committee and included diverse representation of academic, community and adult hospitalists. SHM committee members submitted 150 recommendations for consideration, which were discussed for frequency of occurrence, the uniqueness of the tests and treatments and whether the cost burden for a specific test or treatment proved to be significant, narrowing the list to 65 items. The Choosing Wiselysubcommittee ranked these items and a survey was sent to all SHM members to arrive at 11 recommendations, of which the final five were determined utilizing the Delphi method. SHM’s Board approved the final recommendations.

SHM’s disclosure and conflict of interest policy can be found at www.hospitalmedicine.org.

Sources

Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, Holcomb JB, Illoh O, Kaplan LJ, Katz LM, Rao SV, Roback JD, Shander A, Tobian AA, Weinstein R, Swinton McLaughlin LG, Djulbegovic B; Clinical Transfusion Medicine Committee of the AABB.Red blood cell transfusion: A clinical practice guideline from the AABB. Ann Intern Med [Internet]. 2012 Jul 3 [cited 2012 Sep 4];157(1):49-58.

Consensus conference. Perioperative red blood cell transfusion. JAMA. 1988 Nov 11; 260(18):2700-3.

Advancing Transfusion and Cellular Therapies Worldwide. AABB name change. [Internet]. 2012 [Cited 2012 Oct 15]. Available from: www.aabb.org/about/who/Pages/namechange.aspx.