A 70-year-old man undergoing elective colorectal surgery is given restrictive transfusion strategy. The TRICC trial threshold for RBC transfusion in non-cardiac critically ill patients and the FOCUS trial for hip fracture surgery both established which haemoglobin trigger as safe for transfusion in haemodynamically stable patients?

• A Hb <10 g/dL
• B Hb <9 g/dL
• C Hb <8 g/dL (transfusion trigger: Hb 7–8 g/dL) ✓
• D Hb <11 g/dL

Explanation

The TRICC trial (Hébert et al., NEJM 1999) established that a restrictive transfusion strategy (trigger Hb <7 g/dL, maintain 7–9 g/dL) was at least as safe as a liberal strategy (trigger <10 g/dL) in stable critically ill patients, with similar or lower 30-day mortality. The FOCUS trial (Carson et al., NEJM 2011) similarly showed no benefit of liberal transfusion (Hb <10 g/dL trigger) over restrictive (Hb <8 g/dL trigger) in hip fracture patients with cardiovascular risk factors. Both trials established Hb 7–8 g/dL as the safe trigger for transfusion in stable non-cardiac surgical/ICU patients. An exception is made for patients with active coronary ischaemia where Hb <8 g/dL is the threshold.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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