Update of Red Blood Cell Transfusion Guidelines

Red blood cell transfusion is a key supportive therapy across critical care, surgical, and medical settings.However, excessive transfusion is associated with adverse outcomes and the inefficient use of limited blood resources.Traditionally, restrictive transfusion strategies have been shown to be as safe as liberal strategies in many populations, and this evidence has been incorporated into national and international guidelines and quality evaluations.However, recent data challenge the universal applicability of restrictive thresholds for acute myocardial infarction (AMI) and acute brain injury (ABI).Large, randomized trials such as the Myocardial Ischemia and Transfusion trial (MINT) and the REstrictive And LIberal Transfusion strategies in patients with AMI trial (REALITY), together with updated Association for the Advancement of Blood & Biotherapies (AABB) guidelines, now favor a liberal strategy around hemoglobin 10 g/dL in AMI.Similarly, a 2025 Cochrane review incorporating trials including the TRansfusion Requirements After Head Trauma trial (TRAHT), SubArachnoid Haemorrhage Red-cell transfusion And Outcome (SAHaRA), TRansfusion Strategies in Acute Brain INjured Patients (TRAIN), and HEMOglobin Transfusion Threshold in Traumatic brain Injury OptimizatioN (HEMOTION) suggests that restrictive thresholds may worsen neurologic outcomes in ABI.Overall, these evolving data highlight the need for a continuous reassessment of transfusion thresholds and careful, context-specific clinical application of guideline recommendations.(Korean J Blood Transfus 2025;36:172-175) Key words: Transfusion, Acute myocardial infarction, Acute brain injury, Red blood cell, Transfusion guidelines, Transfusion threshold 적혈구 수혈(red blood cell transfusion)은 중환 자, 수술, 내과적 질환 등 많은 임상 상황에서 필 수적인 치료지만, 과다 수혈은 감염, 순환부전, 면 역억제 등 부작용을 초래하며 혈액 자원의 효율 적인 분배에도 영향을 미친다.적혈구 수혈에 있 어서 적절한 기준점(threshold)