3.3 Effect of red blood cell transfusion on outcomes
Question 5 (Interventional question) (GNQ2)
In patients undergoing surgery, what is the effect of RBC transfusion on patient outcomes?
RBC, red blood cell
Thirty-seven studies were identified that assessed the effect of transfusions on outcomes; of these, 21 involved cardiac surgery and 16 noncardiac surgery. These studies were all Level III (of poor to fair quality) and did not control who did or did not receive the intervention (RBC transfusion). Many studies demonstrated a dose-dependent relationship between RBC transfusion and morbidity or mortality. However, the design of the studies was such that it was not possible to prove a causal relationship between the intervention and the observed outcomes.
The CRG has made no assumption of causality; however, an association between red cell transfusion and adverse patient outcome has been reported. Therefore, the CRG advocates a precautionary approach to blood transfusion, balancing the potential harms of blood transfusion and anaemia.
The paucity of evidence in this area to guide clinical practice has been highlighted by the recent publication from the International Consensus Conference on Transfusion Outcomes (ICCTO) group. 60