Use of red cells

Patient blood management

Patient blood management aims to improve clinical outcomes by avoiding unnecessary exposure to blood components. Ideally each patient will have an individual management plan aimed at conserving their own blood. For red cell transfusion, the following should be considered:

Red cells may be used for treatment of clinically significant anaemia with symptomatic deficit of oxygen carrying capacity. This may occur in the context of unstable medical patients or for replacement of traumatic or surgical blood loss.

Red cell transfusion should not be a default decision. Instead, the decision on whether to transfuse should be carefully considered, taking into account the full range of available therapies, and balancing the evidence for efficacy and improved clinical outcome against the potential risks.(1)

Red cell transfusion should not be dictated by a haemoglobin 'trigger' alone, but should be based on assessment of the patients' clinical status. Many studies have found restrictive transfusion practice to be equal or superior to liberal transfusion practices.(1–5)

The National Blood Authority Patient Blood Management Guidelines have been developed to support clinical decisions about appropriate transfusion practices and the use of blood components.

Some blood components are modified for specific indications and patient groups.

Do not use red cells if anaemia can be treated with specific medications such as iron, vitamin B12, folic acid or recombinant erythropoietin and the clinical condition of the patient permits sufficient time for these agents to promote erythropoiesis. See Anaemia and haemostasis management for more information.

In general transfusion of a single unit of RBC followed by clinical reassessment to determine the need for further transfusion, is appropriate.(2-5) Post-transfusion Hb check is not mandatory but may be useful in some clinical situations.

Each unit of red cells raises the haemoglobin concentration in an average sized adult by approximately 10 g/L.(6)

Use blood of identical ABO and RhD group as the recipient whenever possible.

However, group O RhD negative red cells are used in an emergency when the recipient’s blood group is unknown. In this situation, a blood sample should be taken for blood grouping prior to commencing transfusion.(7)

  1. National Blood Authority. Patient Blood Management Guidelines: Module 2–Perioperative. Australia, 2012.
  2. National Blood Authority. Patient Blood Management Guidelines: Module 3–Medical. Australia, 2012.
  3. National Blood Authority. Patient Blood Management Guidelines: Module 4–Critical care. Australia, 2012.
  4. National Blood Authority. Patient Blood Management Guidelines: Module 5-Obstetrics and Maternity. Australia 2015
  5. National Blood Authority. Patient Blood Management Guidelines: Module 6-Neonatal and Paediatrics. Australia 2016
  6. Australian Red Cross Lifeblood. Blood Component Information: An Extension of Blood Component Labels.
  7. Australian and New Zealand Society of Blood Transfusion. Guidelines for Transfusion and Immunohaematology Laboratory Practice, 1st Edition (revised): January 2020