▪ Objective: To review the literature on the appropriateness of
red blood cell transfusion and current physician practice, with
emphasis on the physiologic and symptomatic implications of
elective transfusion in the treatment of anemia. ▪ Data Sources:
Studies on the therapeutic use of red blood cell transfusion
were identified through a search of MEDLINE (1966 to the
present) and through a manual review of bibliographies of
identified articles. In addition, evidence was solicited from
selected experts in the field and recent consensus panels that
have developed transfusion guidelines. ▪ Data Synthesis: No
controlled trials of blood transfusion were identified, but data
were available on four issues relevant to transfusion practice:
current physician practice and evidence for excessive use of red
blood cell transfusion; physiologic adaptation to anemia; human
tolerance of low hemoglobin levels; and strategies for reducing
homologous transfusion requirements. ▪ Conclusions: Despite the
recent decline in red bl