The TRICC trial established a restrictive versus liberal transfusion strategy in critically ill patients. The threshold for red blood cell transfusion in the restrictive group was Hb <7 g/dL (target 7–9 g/dL), versus Hb <10 g/dL in the liberal group. The trial showed:

• A Liberal transfusion significantly improved 30-day mortality in all critically ill patients
• B Restrictive transfusion was equivalent or superior to liberal transfusion; 30-day mortality trended lower in the restrictive group (especially in younger, less severely ill patients) ✓
• C Restrictive transfusion was associated with significantly higher rates of acute myocardial infarction
• D Both strategies had equivalent outcomes in patients with ischaemic heart disease

Explanation

The TRICC trial (Hébert et al., NEJM 1999) demonstrated that a restrictive transfusion strategy (Hb <7 g/dL) was as safe as, and in certain subgroups (APACHE II <20 or age <55) significantly better than, a liberal strategy (Hb <10 g/dL) in ICU patients. The 30-day mortality was 18.7% (restrictive) vs 23.3% (liberal), approaching significance (p=0.11). This trial fundamentally changed transfusion practice and supports current Hb 7–8 g/dL thresholds in most non-cardiac surgical patients.

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

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