In this post about transfusion thresholds in elderly patients undergoing surgery for hip fracture, I indulged in a rant about the irresistible but dodgy lure of transfusing hospitalized patients with anemia (which I attributed to the normalization heuristic) and the wastefullness and potential harms it entails. But I also hedged my bets, stating that I could get by with transfusing only one unit of blood a month in non-acutely bleeding patients, while noting in a comment that a Cochrane review of this population was equivocal and the authors suggested an RCT of transfusion in acute upper gastrointestinal hemorrhage. Little did I know at the time that just such a trial was nearing completion, and that 12 units of PRBCs could probably get me by for a year in just about all the patients I see.In this article by Villanueva in the January 3, 2013 issue of the NEJM, Spanish investigators report the results of a trial of transfusion thresholds in patients with acute upper gastrointestinal hemorrhage. After receiving one unit of PRBCs for initial stabalization, such patients were randomized to receive transfusions at a hemoglobin threshold of 7 versus 9 mg/dL. And lo! - the probability of transfusion was reduced 35%, survival increased by 4%, rebleeding decreased by 4%, and adverse events decreased by 8% in the lower threshold group - all significant! So it is becoming increasingly clear that the data belie the sophomoric logic of transfusion.
