Is there a “magic” hemoglobin number

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Full title: Is there a “magic” hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices [1]

Written by: Tim Goodnough and Neil Shah


This article considers seven clinical trials in adults that shows Level 1 evidence to support restrictive transfusion practices. This article also discusses the idea of a “magic number” for hemoglobin (Hb) threshold level for ordering red blood cell (RBC) transfusions.

Methods/Data Collection

The writers considered nineteen randomized trials and seven randomized clinical trials that compared Hb levels as “high vs. low” or “restrictive vs. liberal.”


Key Clinical Trials: For the nineteen randomized trials “low Hb levels” were well tolerated and that RBC transfusions were reduced. For the seven randomized clinical trials found that there were no differences between “restrictive” and “liberal” RBC transfusions.

Clinical Practices Guidelines: The American College of Physicians could not come up with a “trigger” number for Hb levels for transfusions. Instead they recommended a full clinical assessment of the patient. However, new editorials suggest that maybe there is a “magic number” Hb level of 6 g/dl or 7g/dl but there are many problems with this idea.


The authors also look at other strategies for improving blood utilization: educational interventions and clinical decision support (CDS). The authors consider clinical decision support is a strong tool for improving blood utilization even without a “magic number” Hb level.


This is an interesting article because it discusses the difficulty of finding an easy or “magic” number for Hb levels for blood transfusions. The decision to transfuse a patient must be based on the immediate clinical history, which complicates efforts to use a CDS to standardize the process. As such a "magic number" has not been found yet but there are likely promising ways that CDS can help to limit errors with blood transfusions.

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  1. Goodnough, L. T., & Shah, N. (2015). Is there a "magic" hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices. American Journal of Hematology, 90(10), 927-933. doi:10.1002/ajh.24101