Assessment of the indication for transfusion of red blood cells according to evidence-based practice and a brief overview of education in transfusion medicine




Higher Education; Professional Training; Transfusion Medicine; Medical Education; Evidence-based practice.


Objectives:  assess whether the indications for transfusion of red blood cells in a large hospital in São Paulo follow evidence-based recommendations. Method: Quantitative and descriptive retrospective study based on obtaining information through requisition forms for Hemotherapeutic procedures. Results:  229 requisition forms were evaluated from September to October 2021. The mean age of the sample was 56.9 years ± 16.4, composed mostly of men 54.6%. Intensive care units were the places with the highest number of requests (52.4%). Symptomatic anemia was the main indication for transfusion (70.7%), followed by active bleeding (24.5%). Among the comorbidities, neoplasms (27.9%) were the most prevalent. The mean hemoglobin values were 6.84g/dL ±1.13 and the mean hematocrit values were 21.0% ± 3.42. The absolute value of hemoglobin was greater than 7.0g/dL in 40.6% of the 229 files and 10.5% of the total, with values equal to or greater than 8.0g/dL. Conclusion: the indication for red blood cell transfusions doesn’t follow the recommendations of evidence-based practice in the studied sample, being necessary to provide training to students and professionals, with the aim of improving the quality of prescribing criteria.


Ait Bouchrim, S. A., Haddad, A., Bou Assi, T., Oriol, P., Guyotat, D., Bois, C., & Garraud, O. (2020). Residents' knowledge in transfusion medicine and educational programs: A pilot study. Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine, 27(1), 18–24.

Albarqouni, L., Hoffmann, T., & Glasziou, P. (2018). Evidence-based practice educational intervention studies: a systematic review of what is taught and how it is measured. BMC medical education, 18(1), 177

Brasil. (2015). Guia para uso de hemocomponentes. segunda edição.

Carson, J. L., Terrin, M. L., Noveck, H., Sanders, D. W., Chaitman, B. R., Rhoads, G. G., Nemo, G., Dragert, K., Beaupre, L., Hildebrand, K., Macaulay, W., Lewis, C., Cook, D. R., Dobbin, G., Zakriya, K. J., Apple, F. S., Horney, R. A., Magaziner, J., & FOCUS Investigators (2011). Liberal or restrictive transfusion in high-risk patients after hip surgery. The New England journal of medicine, 365(26), 2453–2462.

Carson, J. L., Brooks, M. M., Abbott, J. D., Chaitman, B., Kelsey, S. F., Triulzi, D. J., Srinivas, V., Menegus, M. A., Marroquin, O. C., Rao, S. V., Noveck, H., Passano, E., Hardison, R. M., Smitherman, T., Vagaonescu, T., Wimmer, N. J., & Williams, D. O. (2013). Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. American heart journal, 165(6), 964–971.e1.

Carson, J. L., Stanworth, S. J., Dennis, J. A., Trivella, M., Roubinian, N., Fergusson, D. A., Triulzi, D., Dorée, C., & Hébert, P. C. (2021). Transfusion thresholds for guiding red blood cell transfusion. The Cochrane database of systematic reviews, 12(12), CD002042.

Chong, M. A., Krishnan, R., Cheng, D., & Martin, J. (2018). Should Transfusion Trigger Thresholds Differ for Critical Care Versus Perioperative Patients? A Meta-Analysis of Randomized Trials. Critical care medicine, 46(2), 252–263.

de Almeida, J. P., Vincent, J. L., Galas, F. R., de Almeida, E. P., Fukushima, J. T., Osawa, E. A., Bergamin, F., Park, C. L., Nakamura, R. E., Fonseca, S. M., Cutait, G., Alves, J. I., Bazan, M., Vieira, S., Sandrini, A. C., Palomba, H., Ribeiro, U., Jr, Crippa, A., Dalloglio, M., Diz, M., & Hajjar, L. A. (2015). Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial. Anesthesiology, 122(1), 29–38.

Delaney, M., Wendel, S., Bercovitz, R. S., Cid, J., Cohn, C., Dunbar, N. M., Apelseth, T. O., Popovsky, M., Stanworth, S. J., Tinmouth, A., Van De Watering, L., Waters, J. H., Yazer, M., Ziman, A., & Biomedical Excellence for Safer Transfusion (BEST) Collaborative (2016). Transfusion reactions: prevention, diagnosis, and treatment. Lancet, 388(10061), 2825–2836.

Ducrocq, G., Gonzalez-Juanatey, J. R., Puymirat, E., Lemesle, G., Cachanado, M., Durand-Zaleski, I., Arnaiz, J. A., Martínez-Sellés, M., Silvain, J., Ariza-Solé, A., Ferrari, E., Calvo, G., Danchin, N., Avendaño-Solá, C., Frenkiel, J., Rousseau, A., Vicaut, E., Simon, T., Steg, P. G., & REALITY Investigators (2021). Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial. JAMA, 325(6), 552–560.

Eichbaum, Q., Shan, H., Goncalez, T. T., Duits, A. J., Knox, P., Reilly, J., & Andrews, D. (2014). Global health and transfusion medicine: education and training in developing countries. Transfusion, 54(7), 1893–1898.

Flausino, G., Nunes, F. F., Cioffi, J. G., & Proietti, A. B. (2015). Teaching transfusion medicine: current situation and proposals for proper medical training. Revista brasileira de hematologia e hemoterapia, 37(1), 58–62.

Franchini, M., Marano, G., Mengoli, C., Pupella, S., Vaglio, S., Muñoz, M., & Liumbruno, G. M. (2017). Red blood cell transfusion policy: a critical literature review. Blood transfusion = Trasfusione del sangue, 15(4), 307–317.

Franchini, M., Marano, G., Veropalumbo, E., Masiello, F., Pati, I., Candura, F., Profili, S., Catalano, L., Piccinini, V., Pupella, S., Vaglio, S., & Liumbruno, G. M. (2019). Patient Blood Management: a revolutionary approach to transfusion medicine. Blood transfusion = Trasfusione del sangue, 17(3), 191–195.

Frazier, S. K., Higgins, J., Bugajski, A., Jones, A. R., & Brown, M. R. (2017). Adverse Reactions to Transfusion of Blood Products and Best Practices for Prevention. Critical care nursing clinics of North America, 29(3), 271–290.

Graham, J. E., Narayan, S., & Pendry, K. (2017). Improving transfusion education for junior doctors; exploring UK experiences. Transfusion medicine, 27(2), 96–104.

Gregersen, M., Borris, L. C., & Damsgaard, E. M. (2015). Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture: the TRIFE randomized controlled trial. Acta orthopaedica, 86(3), 363–372.

Hajjar, L. A., Vincent, J. L., Galas, F. R., Nakamura, R. E., Silva, C. M., Santos, M. H., Fukushima, J., Kalil Filho, R., Sierra, D. B., Lopes, N. H., Mauad, T., Roquim, A. C., Sundin, M. R., Leão, W. C., Almeida, J. P., Pomerantzeff, P. M., Dallan, L. O., Jatene, F. B., Stolf, N. A., & Auler, J. O., Jr (2010). Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA, 304(14), 1559–1567.

Hébert, P. C., Wells, G., Blajchman, M. A., Marshall, J., Martin, C., Pagliarello, G., Tweeddale, M., Schweitzer, I., & Yetisir, E. (1999). A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. The New England journal of medicine, 340(6), 409–417.

Holst, L. B., Haase, N., Wetterslev, J., Wernerman, J., Guttormsen, A. B., Karlsson, S., Johansson, P. I., Aneman, A., Vang, M. L., Winding, R., Nebrich, L., Nibro, H. L., Rasmussen, B. S., Lauridsen, J. R., Nielsen, J. S., Oldner, A., Pettilä, V., Cronhjort, M. B., Andersen, L. H., Pedersen, U. G., & Scandinavian Critical Care Trials Group (2014). Lower versus higher hemoglobin threshold for transfusion in septic shock. The New England journal of medicine, 371(15), 1381–1391.

Holst, L. B., Petersen, M. W., Haase, N., Perner, A., & Wetterslev, J. (2015). Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ, 350, h1354.

Jones, J. M., Sapiano, M., Savinkina, A. A., Haass, K. A., Baker, M. L., Henry, R. A., Berger, J. J., & Basavaraju, S. V. (2020). Slowing decline in blood collection and transfusion in the United States - 2017. Transfusion, 60 Suppl 2(Suppl 2), S1–S9.

Kelly, S., Belisário, A. R., Werneck Rodrigues, D. O., Carneiro-Proietti, A., Gonçalez, T. T., Loureiro, P., Flor-Park, M. V., Maximo, C., Mota, R. A., Dinardo, C., Brambilla, D., Preiss, L., Sabino, E., Custer, B., & NHLBI Recipient Epidemiology Donor Evaluation Study (REDS-III) International Component-Brazil (2020). Blood utilization and characteristics of patients treated with chronic transfusion therapy in a large cohort of Brazilian patients with sickle cell disease. Transfusion, 60(8), 1713–1722.

Lin, Y., Tinmouth, A., Mallick, R., Haspel, R. L., & BEST-TEST2 Investigators. (2016). BEST-TEST2: assessment of hematology trainee knowledge of transfusion medicine. Transfusion, 56(2), 304–310.

Liumbruno, G. M., Vaglio, S., Biancofiore, G., Marano, G., Mengoli, C., & Franchini, M. (2016). Transfusion thresholds and beyond. Blood transfusion = Trasfusione del sangue, 14(2), 123–125.

Mazer, C. D., Whitlock, R. P., Fergusson, D. A., Hall, J., Belley-Cote, E., Connolly, K., Khanykin, B., Gregory, A. J., de Médicis, É., McGuinness, S., Royse, A., Carrier, F. M., Young, P. J., Villar, J. C., Grocott, H. P., Seeberger, M. D., Fremes, S., Lellouche, F., Syed, S., Byrne, K., & TRICS Investigators and Perioperative Anesthesia Clinical Trials Group (2017). Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. The New England journal of medicine, 377(22), 2133–2144.

Møller, A., Nielsen, H. B., Wetterslev, J., Pedersen, O. B., Hellemann, D., Winkel, P., Marcussen, K. V., Ramsing, B., Mortensen, A., Jakobsen, J. C., & Shahidi, S. (2019). Low vs high hemoglobin trigger for transfusion in vascular surgery: a randomized clinical feasibility trial. Blood, 133(25), 2639–2650.

O'Brien, K. L., Champeaux, A. L., Sundell, Z. E., Short, M. W., & Roth, B. J. (2010). Transfusion medicine knowledge in Postgraduate Year 1 residents. Transfusion, 50(8), 1649–1653.

Panzer, S., Engelbrecht, S., Cole-Sinclair, M. F., Wood, E. M., Wendel, S., Biagini, S., Zhu, Z., Lefrère, J. J., Andreu, G., Zunino, T., Cabaud, J. J., Rouger, P., Garraud, O., Janetzko, K., Müller-Steinhardt, M., van der Burg, P., Brand, A., Agarwal, P., Triyono, T., Gharehbaghian, A., & Reesink, H. W. (2013). Education in transfusion medicine for medical students and doctors. Vox sanguinis, 104(3), 250–272.

Peedin A. R. (2021). Update in Transfusion Medicine Education. Clinics in laboratory medicine, 41(4), 697–711.

Pereira, A. S., et. al. (2018). Free e-book: Metodologia da pesquisa científica. Santa Maria/RS. Ed. UAB/NTE/UFSM.

Tay, J., Allan, D. S., Chatelain, E., Coyle, D., Elemary, M., Fulford, A., Petrcich, W., Ramsay, T., Walker, I., Xenocostas, A., Tinmouth, A., & Fergusson, D. (2020). Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial. Journal of clinical oncology, 38(13), 1463–1473.

Vaena, M., & Alves, L. A. (2019). Assessment of the knowledge and perceptions of Brazilian medical residents on transfusion medicine. Hematology, transfusion and cell therapy, 41(1), 37–43.

Vamvakas, E. C., & Blajchman, M. A. (2009). Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood, 113(15), 3406–3417



How to Cite

BRUNETTO, M. L.; GARCIA, R. R. .; MOLINARI, H.; ARAUJO, A. C. Assessment of the indication for transfusion of red blood cells according to evidence-based practice and a brief overview of education in transfusion medicine. Research, Society and Development, [S. l.], v. 11, n. 14, p. e263111435964, 2022. DOI: 10.33448/rsd-v11i14.35964. Disponível em: Acesso em: 25 sep. 2023.



Teaching and Education Sciences