SynthesisBMC medicine2020
Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: an overview of systematic reviews.
Synthesis in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support.The Cochrane database of systematic reviews · 2024Pooled it
- Systematic Review and Meta-Analysis on the Role of Perioperative Blood Transfusion in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma.Bladder cancer (Amsterdam, Netherlands) · 2022Pooled it
- Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021Pooled it
- Role of preoperative intravenous iron therapy to correct anemia before major surgery: a systematic review and meta-analysis.Systematic reviews · 2021Pooled it
- Molecular Mechanisms of Transfusion-Associated Immunomodulation and Its Impact in the Critically Ill.International journal of molecular sciences · 2025Review
- Perioperative Blood Management.Journal of clinical medicine · 2025Review
- Mortality in Critically Ill Patients with Liberal Versus Restrictive Transfusion Thresholds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis.Journal of clinical medicine · 2025Review
- Effectiveness of training programs on the knowledge of midwifes and nursing responsibilities during blood transfusion at Nasser medical complex, Palestine.Journal of education and health promotion · 2025Article
- Restrictive versus liberal transfusion thresholds: lights and shadows.Blood transfusion = Trasfusione del sangue · 2025Article
- Exploring the Intersection of Blood Transfusion and Same-Day Computed Tomography Imaging: An Overview of Clinical Risks and Practices.Diagnostics (Basel, Switzerland) · 2024Review
- [Special features of the perioperative course in patients with frailty syndrome].Die Anaesthesiologie · 2023Article
- Multivariable statistical models to predict red cell transfusion in elective surgery.Blood transfusion = Trasfusione del sangue · 2023Article
- The Limits of Acute Anemia.Journal of clinical medicine · 2022Review
- [Optimal oxygen administration-new evidence from treating COVID-19?]Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2022Review
- Acute Upper Non-variceal and Lower Gastrointestinal Bleeding.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2022Review
- Emergency Blood Transfusion for Trauma and Perioperative Resuscitation: Standard of Care.Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2021Review
- Appropriate red cell transfusions are often avoidable through Patient Blood Management.Blood transfusion = Trasfusione del sangue · 2021Article
- RBC Transfusion Triggers: Is There Anything New?Transfusion medicine and hemotherapy : offizielles Organ der Deutschen Gesellschaft fur Transfusionsmedizin und Immunhamatologie · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere are no overviews of systematic reviews investigating haemoglobin thresholds for transfusion. This is important as the literature on transfusion thresholds has grown considerably in recent years. Our aim was to synthesise evidence from systematic reviews and meta-analyses of the effects of restrictive and liberal transfusion strategies on mortality.
methodsThis was a systematic review of systematic reviews (overview). We searched MEDLINE, Embase, Web of Science Core Collection, PubMed, Google Scholar, and the Joanna Briggs Institute EBP Database, from 2008 to 2018. We included systematic reviews and meta-analyses of randomised controlled trials comparing mortality in patients assigned to red cell transfusion strategies based on haemoglobin thresholds. Two independent reviewers extracted data and assessed methodological quality. We assessed the methodological quality of included reviews using AMSTAR 2 and the quality of evidence pooled using an algorithm to assign GRADE levels.
resultsWe included 19 systematic reviews reporting 33 meta-analyses of mortality outcomes from 53 unique randomised controlled trials. Of the 33 meta-analyses, one was graded as high quality, 15 were moderate, and 17 were low. Of the meta-analyses presenting high- to moderate-quality evidence, 12 (75.0%) reported no statistically significant difference in mortality between restrictive and liberal transfusion groups and four (25.0%) reported significantly lower mortality for patients assigned to a restrictive transfusion strategy. We found few systematic reviews addressed clinical differences between included studies: variation was observed in haemoglobin threshold concentrations, the absolute between group difference in haemoglobin threshold concentration, time to randomisation (resulting in transfusions administered prior to randomisation), and transfusion dosing regimens.
conclusionsMeta-analyses graded as high to moderate quality indicate that in most patient populations no difference in mortality exists between patients assigned to a restrictive or liberal transfusion strategy.
trial registrationPROSPERO CRD42019120503.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.