Review of published recommendations and guidelines for the transfusion of allogeneic red blood cells and plasma.

Abstract

Objective: To evaluate published guidelines and recommendations for the transfusion of allogeneic red blood cells and plasma in terms of content and methods. Evidence: Bibliographic search of MEDLINE database for articles making therapeutic recommendations regarding erythrocyte and plasma transfusion, between January 1966 and July 1996; manual search of bibliographies from relevant reviews, guidelines and textbooks. Data synthesis: Evaluation focused on how the evidence was identified, selected and incorporated. Therapeutic recommendations were compared and contrasted. Time trends related to transfusion triggers were also examined. Results: The 59 references that met our criteria consisted of 17 clinical practice guidelines (CPGs) and 42 reviews. Five CPGs addressed the use of allogeneic red blood cells, 4 focused on fresh frozen plasma and 8 did both. All CPGs were based on the recommendations of an expert panel, although no specific consensus process was described. Among the 17 CPGs, only 1 used a computerized literature search and grading of the evidence and the strength of the individual recommendations. None of the CPGs cited or discussed the few available randomized, controlled clinical trials published at least 6 months earlier. For red blood cells, only 1 set of guidelines recommended a transfusion trigger; 6 advocated a range of transfusion thresholds based on clinical judgement; 1 recommended using only clinical judgement; the 5 remaining guidelines did not comment on either. For plasma, guidelines recommended an assessment of the coagulation cascade and the risk of ongoing bleeding before administration. Conclusions: Although several agencies have published guidelines for the use of red blood cells and plasma, rigorous, evidence-based guidelines in this area are still needed.