A patient with a haemoglobin of 6.5 g/dL is symptomatic with tachycardia and dyspnoea at rest. Based on standard transfusion triggers, what is the MOST appropriate transfusion decision?

• A Do not transfuse; the threshold is Hb < 6 g/dL regardless of symptoms
• B Transfuse only if the patient has active cardiac ischaemia
• C Administer IV iron and erythropoietin before considering transfusion
• D Transfuse; the haemoglobin is below 7 g/dL in a symptomatic patient ✓

Explanation

Current guidelines (AABB, British Committee for Standards in Haematology) recommend a restrictive transfusion strategy with a threshold of Hb 7 g/dL in most stable hospitalised patients. However, in symptomatic patients — those with tachycardia, dyspnoea, angina, or hypotension attributable to anaemia — transfusion is indicated even at Hb 7–8 g/dL or above the strict numerical threshold. With Hb 6.5 g/dL and active symptoms, transfusion is clearly appropriate. IV iron and erythropoietin are useful for preoperative optimisation but have no role in managing acute symptomatic anaemia.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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