Safety of anemia compared to blood transfusions

By James Ji, MD

James Ji, MD


Red blood cells are the vehicle for carrying oxygen to vital organs within the body and a low concentration of these cells (also known as anemia) can cause a wide range of symptoms from mild fatigue to risk for organ failure depending on severity (measured by level of hemoglobin). In an ill patient, care providers often correct anemia using blood transfusions, but transfusions have inherent risk and have been associated with elevated risks for death and infections. Therefore, medicine has been attempting to identify the level at which the risks of transfusions outweigh the risks of severe anemia. Several large clinical trials including intensive care unit patients, high risk hip surgery patients, and patients with gastrointestinal bleeds all show that allowing for anemia to a certain degree leads to improved or unchanged outcomes compared with aggressively correcting anemia with blood transfusions. Conversely, in patients with heart attacks, large studies are lacking but smaller studies suggest that transfusing to correct anemia may decrease death. At this time, we don’t truly know how anemic a patient can get before they “must” have a transfusion, but most doctors associate a level of ~7 mg/dL hemoglobin as a general cutoff where there may be advantages to transfusions for most cases. However, every patient is different and the risks and benefits change depending on each patient’s condition. In patients who choose not to have blood transfusions in their care, the transfusion-free service at Keck USC attempts to prevent and treat anemia with blood conserving technology, reduced blood draws, and non-invasive monitoring techniques while augmenting blood counts with therapies including bone marrow stimulation and iron supplementation.

When deciding whether or not to transfuse, every doctor needs to weigh the relative risks and benefits, as well as the preferences of each patient. Fortunately, our experienced surgeons at Keck USC have been able to help many patients surgically at very low hemoglobin counts. Whenever possible, our surgeons will stabilize patients and send them home to prep for their surgery by undergoing aggressive anemia correction therapy. Once the patient reaches a safer blood count, they are then ready for surgery.