Correspondence  |   March 1997
What Is the Transfusion Trigger? What Is the Message?
Author Notes
  • Professor and Chairman of Anesthesia, Professor of Molecular and Cellular Pharmacology, University of California, San Francisco, Department of Anesthesia, 521 Parnassus Avenue, Box 0648, San Francisco, California 94143–0648 (Miller).
Article Information
Correspondence   |   March 1997
What Is the Transfusion Trigger? What Is the Message?
Anesthesiology 3 1997, Vol.86, 750. doi:
Anesthesiology 3 1997, Vol.86, 750. doi:
To the Editor:-The Practice Guidelines for Blood Component Therapy, [1] developed by an American Society of Anesthesiologists' Task Force, may well be the most important guide for transfusion therapy available to us. These guidelines are designed to influence our overall approach to transfusion therapy. [1] It is important, therefore, that the messages of this document be clear. However, the information in the abstract regarding the transfusion “trigger” is unclear. First is the statement that there is no single hemoglobin “trigger” and that red blood cell transfusion should, instead, be based on the patient's risk for developing inadequate oxygenation (i.e., this assumes that we can quantitate such risk). Second is the statement that red blood cell transfusions are almost always required when the hemoglobin level is less than 6 g/dl and rarely indicated when hemoglobin levels are more than 10 g/dl.
These sentences could be viewed as contradictory to each other. The first statement discourages, whereas the second statement encourages, the use of hemoglobin levels as a guide to red blood cell transfusions. Therefore, when combined, the resulting message regarding the diagnostic value of hemoglobin levels is confusing, and, therefore, should be restated. One possibility would be to state that the transfusion trigger usually is between 6 and 10 g/dl, and that a judgment of the risks of inadequate oxygen-carrying capacity should dictate at what point between these hemoglobin values red blood cell transfusion should be initiated. In addition, the abstract should indicate that hemoglobin level is one of several important criteria for determining the need for red blood cell transfusion.
Ronald D. Miller, M.D.
Professor and Chairman of Anesthesia; Professor of Molecular and Cellular Pharmacology
University of California, San Francisco; Department of Anesthesia
521 Parnassus Avenue, Box 0648; San Francisco, California 94143–0648
(Accepted for publication December 18, 1996.)
Practice guidelines for blood component therapy: A report by the American Society of Anesthesiologists' Task Force on Blood Component Therapy. Anesthesiology 1996; 84:732-47.