Establishing causation in transfusion medicine and related tribulations.

摘要

BOTH BLOOD BANKERS and clinicians practiced "faith-based" medicine for 5 decades (1940-2000) by transfusing red blood cells (RBCs) to patients with hemoglobin falling to less than or equal to 10 g/dL.' The Transfusion Requirements in Critical Care (TRICC) randomized controlled trial (RCT) then demonstrated that, without adverse outcomes, a transfusion trigger of 7 g/dL produced a result superior to a transfusion trigger of 10 g/dL.2 In fact, normovolemic intensive care unit (ICU) patients randomized to receive RBCs for a hemoglobin falling to less than or equal to 10 g/dL had a significant (P < .05) increase in the risk of myocardial infarction and pulmonary edema, as well as in-hospital mortality, compared with subjects randomized to receive allogeneic blood transfusion (ABT) for a hemoglobin falling to less than or equal to 7 g/dL.