AHRQ Case and Commentary: Restrictive Transfusion Strategy Safer for Patients with Anemia

In stable, hospitalized patients, a restrictive transfusion strategy using a hemoglobin concentration of 7 to 8 g/dL or using the presence of symptoms of anemia as transfusion thresholds has been shown to be safe, according to the authors of a commentary from the November 2012 edition of the Agency for Healthcare Research and Quality’s (AHRQ) online case study review, WebM&M. In the spotlight case, a 77-year-old woman with chronic myelodysplastic syndrome who underwent an uncomplicated coronary artery bypass grafting procedure for coronary artery disease was admitted to the emergency department (ED) two months later with mild congestive heart failure (CHF). Although her hemoglobin level in the ED was 8.1 g/dL, her oncologist requested that she be admitted to the hospital and transfused with two units of blood to manage anemia associated with her myelodysplastic syndrome. Thirty minutes after the second unit of blood finished transfusing, the patient became lethargic and developed hypoxic respiratory failure from acute volume overload in the setting of CHF or from transfusion-related acute lung injury.