Red Blood Cell Transfusion in the Emergency Department

Brit Long, Alex Koyfman

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background Transfusion of red blood cells (RBCs) is the primary management of anemia, which affects 90% of critically ill patients. Anemia has been associated with a poor prognosis in various settings, including critical illness. Recent literature has shown a hemoglobin transfusion threshold of 7 g/dL to be safe. This review examines several aspects of transfusion. Objective We sought to provide emergency physicians with an updated review of indications for RBC transfusion in the emergency department. Discussion The standard hemoglobin transfusion threshold was 10 g/dL. However, the body shows physiologic compensatory adaptations to chronic anemia. Transfusion reactions and infections are rare but can have significant morbidity and mortality. Products stored for <21 days have the lowest risk of reaction and infection. A restrictive threshold of 7 g/dL is recommended in the new American Association of Blood Banks guidelines and multiple meta-analyses and supported in gastrointestinal bleeding, sepsis, critical illness, and trauma. Patients with active ischemia in acute coronary syndrome and neurologic injury require additional study. The physician must consider the patient's hemodynamic status, comorbidities, risks and benefits of transfusion, and clinical setting in determining the need for transfusion. Conclusions RBC transfusion is not without risks, including transfusion reaction, infection, and potentially increased mortality. The age of transfusion products likely has no effect on products before 21 days of storage. A hemoglobin level of 7 g/dL is safe in the setting of critical illness, sepsis, gastrointestinal bleeding, and trauma. The clinician must evaluate and transfuse based on the clinical setting and patient hemodynamic status rather than using a specific threshold.

Original languageEnglish (US)
Pages (from-to)120-130
Number of pages11
JournalJournal of Emergency Medicine
Issue number2
StatePublished - Aug 1 2016


  • RBC
  • blood product
  • indications
  • product age
  • transfusion
  • transfusion reaction

ASJC Scopus subject areas

  • Emergency Medicine


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