Concepts of blood transfusion in adults

Lancet. 2013 May 25;381(9880):1845-54. doi: 10.1016/S0140-6736(13)60650-9.


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.

Publication types

  • Review

MeSH terms

  • Adult
  • Blood Transfusion / methods*
  • Blood Transfusion / mortality
  • Cardiovascular Diseases / complications
  • Erythrocyte Transfusion / adverse effects
  • Erythrocyte Transfusion / methods
  • Erythrocyte Transfusion / mortality
  • Evidence-Based Medicine
  • Guideline Adherence / standards
  • Hemoglobins / analysis
  • Humans
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Practice Guidelines as Topic
  • Professional Practice / standards
  • Randomized Controlled Trials as Topic
  • Transfusion Reaction


  • Hemoglobins