Transfusion Thresholds and Indications

Modern transfusion practice favors a restrictive red cell strategy with a haemoglobin trigger of seven grams per deciliter for most stable hospitalised adults. Multiple randomized trials including TRICC and TRISS have demonstrated non inferiority and often improved outcomes compared with liberal triggers of nine to ten.

Higher thresholds remain appropriate in selected populations such as ongoing massive haemorrhage, acute coronary syndrome, certain perioperative settings and chronic transfusion dependent disease. Pretransfusion testing and informed consent are required and one unit at a time with reassessment is preferred over routine two unit orders.

Platelet thresholds are typically ten thousand for prophylaxis in stable thrombocytopenia, twenty thousand with infection or fever and fifty thousand for invasive procedures or active bleeding. Plasma is reserved for documented coagulopathy with active bleeding or before high risk procedures rather than for isolated INR elevation.