HNY Policy and Pathway Repository - Hull

Shortage of red blood cells (RBC)

This intervention is commissioned if:

• shortage of RBC is causing haemodynamic instability OR
• shortage of RBC is impeding oxygen delivery to tissues and organs OR
• severe acute anaemia (Hb <70g/litre) is symptomatic and prevents rehabilitation or mobilisation (single unit of blood)

 

Restrictive RBC transfusion thresholds (i.e. only transfusing the minimum number of units to avoid harm and only a single unit at a time) should apply for patients who need RBC transfusions and who do not have:

• major haemorrhage OR
• acute coronary syndrome OR
• chronic anaemia needing regular blood transfusions

 

NICE guidance on thresholds, targets and doses should be followed.

NICE recommend single-unit RBC transfusion for adults (or equivalent based on body weight for children or adults with low body weight) who are not actively bleeding, do not have acute coronary syndrome or need regular blood transfusions for chronic anaemia. This decision should be based on a clinical assessment of each individual patient including their underlying cause of anaemia. They also recommend that after each single‑unit RBC transfusion the patient should be reassessed clinically, have their haemoglobin levels checked and be given further transfusion(s) if required.

 

Several randomised control trials (RCTs) have proven that it is safe to give single-unit RBC transfusions with a restrictive transfusion trigger (pretransfusion haemoglobin level or symptoms of anaemia). After receiving a single-unit RBC transfusion, symptoms may be alleviated enough to make it possible to give alternative anaemia treatment and postpone the need for further blood transfusions.

 

Potential risks and harms associated with RBC transfusions include:

• Pulmonary complications: transfusion of two or more RBC units in succession is associated with an increase in pulmonary oedema or transfusion-associated circulatory overload
• Volume overload
• Haemolysis, particularly for those with sickle cell disease
• Acute transfusion reaction due to allergy
• Transmission of infection

Blood transfusion - EBI

NG24 Blood transfusion NICE