Patient Blood Management Guidelines: Module 1

Critical Bleeding Massive Transfusion

| Future directions |

5.1 Evidence gaps and areas of future research

5.1.4 Effect of red cell transfusion on outcomes

Question 4 (interventional)

In patients with critical bleeding requiring massive transfusion, what is the effect of RBC transfusion on patient outcomes?

RBC, red blood cell

This question is controversial, given the paradox that, although there is increasing evidence of the hazards of receiving allogeneic blood, RBC transfusion may be life saving in the setting of critical bleeding requiring massive transfusion.

The review identified studies that demonstrated an independent association between the amount of RBC transfusion, and mortality and the development of ARDS. However, in the absence of religious or other personal objections to transfusion, it is unacceptable to withhold RBC transfusion due to these risks if doing so is likely to result in death from exsanguination or tissue hypoxia.

Further research is needed to independently evaluate the risks of RBC and component therapy, even in the complex clinical setting of critical bleeding requiring massive transfusion.