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Systematic review with meta analysis
Restrictive red blood cell transfusion strategies appear safe in most clinical settings
  1. Nareg H Roubinian1,
  2. Jeffrey L Carson2
  1. 1Blood Systems Research Institute, San Francisco, California, USA
  2. 2Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  1. Correspondence to : Dr Jeffrey L Carson, Department of Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA; carson{at}

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Substantial progress has been made in generating data to make evidence-based recommendations for red blood cell (RBC) transfusion. Findings from clinical trials suggest that in most clinical settings, a restrictive transfusion strategy, where RBCs are transfused once haemoglobin levels fall below either 7 or 8 g/dL, does not impact mortality compared with liberal transfusion where RBCs are transfused when haemoglobin levels fall below 9–10 g/dL.1 This meta-analysis, incorporating data from five recently published clinical trials, was used to compare the overall risk of death and other adverse events of liberal and restrictive transfusion strategies.


The authors performed a study-level meta-analysis on 31 prospective randomised controlled trials of hospitalised patients (n=9813) where …

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  • Competing interests JLC has authored a systematic review published in the Cochrane database and plans to update it. There has been a large clinical trial published since this paper was published.

  • Provenance and peer review Commissioned; internally peer reviewed.