Red blood cell (RBC) transfusions are necessary to increase a patient’s oxygen carrying capacity. The optimal transfusion trigger remains elusive, but a restrictive transfusion trigger of 7 g/dL has been shown in studies to reduce RBC transfusions without adversely affecting patient outcomes. Patient blood management programs have been shown effective at reducing RBC transfusions. Hemoglobin-based oxygen carriers and induced pluripotent stem cell derived RBCs are being developed to help mitigate RBC shortages and RBC transfusion limitations. Numerous challenges still exist that need to be overcome before they can have widespread clinical use.
Key points
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Red blood cell (RBC) products are a scarce resource so every effort should be made to transfuse them only when necessary and in the least amount possible.
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A restrictive transfusion trigger of 7 g/dL has been shown to reduce usage of RBC products without adversely affecting patient outcomes.
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Published studies on the adoption of patient blood management programs have shown a decrease in blood product utilization.
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Hemoglobin-based oxygen carriers and induced pluripotent stem cell–derived RBCs are being investigated to mitigate RBC shortages and minimize adverse reactions associated with blood product transfusions.
Introduction
James Blundell performed the first successful human blood transfusion in 1818. During World War I, whole blood was transfused by direct transfusion (ie, donor artery to recipient vein) and by World War II, transfusion occurred from whole blood stored in glass bottles. Component therapy began only after the development of plastic bags for the collection and storage of blood by Carl Walter and W.P. Murphy in 1950. Refrigerated centrifuges were used to separate components by density and the prepared components were stored in precollection attached satellite bags. Donor as well as therapeutic apheresis subsequently developed as a result of Edwin Cohn’s centrifuge that separated cellular components from plasma in conjunction with advances in apheresis instrumentation as a result of the collaboration of various fields. This allowed the collection of therapeutic doses of red blood cells (RBCs), platelets, plasma, and granulocytes from donors. This review focuses on RBC component transfusions and discusses the status of RBC transfusion triggers, patient blood management (PBM), and alternatives to RBCs.
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