Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May;12(2):113-124.
doi: 10.1111/jebm.12330. Epub 2018 Dec 3.

Quality of clinical practice guidelines about red blood cell transfusion

Daniel Simancas-Racines  1 , Nadia Montero-Oleas  1 , Robin W M Vernooij  2 , Ingrid Arevalo-Rodriguez  1 , Paulina Fuentes  3 , Ignasi Gich  4 , Ricardo Hidalgo  1 , Maria José Martinez-Zapata  4   5 , Xavier Bonfill  5 , Pablo Alonso-Coello  4
Affiliations

Quality of clinical practice guidelines about red blood cell transfusion

Daniel Simancas-Racines et al. J Evid Based Med. 2019 May.

Abstract

Background: Red blood cell (RBC) transfusions are essential in health care. The quality of recommendations included in clinical practice guidelines (CPG), regarding this intervention, has not been systematically evaluated. This paper systematically assessed CPGs for RBC-transfusion, to appraise their methodological quality, to explore changes in quality over time, and to assess the consistency of the hemoglobin threshold (HT) recommendations.

Methods: We searched for CPGs that included recommendations of RBC-transfusion in generic databases, compiler entities, registries, clearinghouses and guideline developers. Three reviewers extracted data on CPGs characteristics and HT recommendations, independently appraised the quality of the studies using AGREE II and resolved disagreements by consensus.

Results: We examined 16 CPGs. Mean scores (mean ± SD) were: scope and purpose (59.4% ± 19.8%), stakeholder involvement (43.2% ± 22.6%), rigor of development (50% ± 25%), clarity of presentation (74.4% ± 12.6%), applicability (19.4% ± 18.8%), and editorial independence (41% ± 30%). Seven CPGs recommended a restrictive strategy for RBC transfusion; four CPGs gave a guarded statement considering an HT of 7 g/dL, as safe to prescribe an RBC transfusion. Eight CPGs did not provide an HT stating that RBC transfusions should not be prescribed by HT alone.

Conclusions: Only 3 out of the 16 evaluated CPGs were "recommended" by the independent evaluators. Four domains "stakeholder involvement," "rigor of development," applicability," and "editorial independence" had serious shortcomings. Recommendations about the use of an HT for RBC-transfusion were heterogeneous among guidelines. Greater efforts are needed to provide high-quality CPGs in the RBC-transfusion practice.

Keywords: blood transfusion; clinical practice guidelines; red blood cells; systematic review.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Distribution of the standardized domain scores for 16 CPGs. The top and bottom of the box represent the 75th (Q3) and 25th percentile (Q1), respectively, and the band near the middle of the box indicates the 50th percentile (median). The upper and lower ends of the whisker represent Q3 + 1.5× (interquartile range), and Q1‐1.5× (interquartile range), respectively
See this image and copyright information in PMC

References

    1. Vamvakas EC, Blajchman MA. Deleterious clinical effects of transfusion‐associated immunomodulation: fact or fiction. Blood. 2001;97:1180–1195. - PubMed
    1. Vicent JL, Baron JF, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288:1499–1507. - PubMed
    1. Rohde JM, Dimcheff DE, Blumberg N, et al. Health care associated infection after red blood cell transfusion: a systematic review and meta‐analysis. JAMA. 2014;311:1317–1326. - PMC - PubMed
    1. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies . Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198–208. - PubMed
    1. Blood Transfusion and the Anaesthetist: Red Cell Transfusion 2 . London, U.K.: The Association of Anaesthetists of Great Britain and Ireland, https://www.aagbi.org/sites/default/files/bloodtransfusion06.pdf [accessed 15.11.01].

Publication types

LinkOut - more resources