Accepted for Publication: June 26, 2023.
Published Online: October 12, 2023. doi:10.1001/jama.2023.12914
Corresponding Author: Jeffrey L. Carson, MD, Department of Medicine, Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901 (jeffrey.carson@rutgers.edu).
Author Contributions: Drs Carson and Stanworth had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Carson, Stanworth, Guyatt, Valentine, Bakhtary, Cohn, Grossman, Kaplan, Prochaska, Wood, Pagano.
Acquisition, analysis, or interpretation of data: Carson, Stanworth, Guyatt, Dennis, Bakhtary, Cohn, Dubon, Grossman, Gupta, Hess, Jacobson, Kaplan, Lin, Metcalf, Murphy, Pavenski, Prochaska, Raval, Salazar, Saifee, Tobian, So-Osman, Waters, Zantek, Pagano.
Drafting of the manuscript: Carson, Stanworth, Valentine, Dennis, Kaplan, Murphy, Prochaska, Waters, Pagano.
Critical review of the manuscript for important intellectual content: Dennis, Dubon, Hess, Metcalf, Pavenski, Raval, Salazar, Zantek.
Statistical analysis: Carson, Stanworth, Dennis, Hess, Pagano.
Obtained funding: Cohn.
Administrative, technical, or material support: Carson, Valentine, Dennis, Cohn, Hess, Salazar, Tobian, Wood, Pagano.
Supervision: Carson, Stanworth, Guyatt, Cohn, Prochaska, Raval, Waters, Pagano.
Patient perspective: Dubon.
Served as guideline development panelist: Pavenski.
Representative of the International Society of Blood Transfusion: Wood.
Clinical content expert and European representative: So-Osman.
Other: Kaplan, Prochaska.
Part of the committee involved in the guidelines drafting, review, and discussion: Salazar.
Conflict of Interest Disclosures: Dr Carson reported serving as chair of the data and safety monitoring board for Cerrus for a clinical trial on a treatment system to pathogen-reduce human blood products outside the submitted work; being the principal investigator of a National Heart, Lung, and Blood Institute–supported trial called Myocardial Ischemia and Transfusion, which is evaluating transfusion thresholds in patients with acute myocardial infarction; and receiving financial support paid to his institution. Dr Stanworth reported receiving grants for multiple clinical trials of red blood cell transfusion to his institution, but no direct financial benefits outside the submitted work; receiving grants for red blood cell transfusion trials through his institutions; and being employed by NHSBT, who processes and manufactures red blood cells for transfusion in England. Dr Cohn reported being a paid staff member (chief medical officer) of the AABB during the conduct of the study. Dr Kaplan reported receiving a stipend from the Society of Critical Care Medicine for serving as president from 2020 to 2021 outside the submitted work. Dr Lin reported receiving grants from Canadian Blood Services, consulting for Choosing Wisely Canada, and receiving grants from Octapharma outside the submitted work. Dr Metcalf reported receiving speakers honoraria from Cerus Corporation outside the submitted work. Dr Pavenski reported serving as vice chair of the International Collaboration for Transfusion Medicine Guidelines and as director for North Americas, as well as serving on the board of directors for the International Society of Blood Transfusion. Dr Prochaska reported receiving fees for medicolegal consulting outside the submitted work. Dr Raval reported receiving consultancy fees from Sanofi Genzyme outside the submitted work. Dr Saifee reported nonfinancial support from AABB for travel during the conduct of the study. Dr Zantek reported receiving fees from the Association for the Advancement of Blood and Biotherapies for travel to a meeting for guideline development during the conduct of the study; that her spouse is an employee of Boston Scientific and has financial interest in the company and in ENDO International outside the submitted work; and serving on the board of directors for the American Society for Apheresis, BloodNet, External Quality Assurance in Thrombosis and Hemostasis, and the North American Specialized Coagulation Laboratory Association. No other disclosures were reported.
Funding/Support: Support for guideline development was provided by AABB, Bethesda, Maryland; and international partner organizations.
Additional Contributions: Maria-Helini Trivella, PhD (London School of Hygiene and Tropical Medicine), provided statistical advice without compensation. Panel and Guideline Group members: The panel included current or former members of the AABB Clinical Transfusion Medicine Committee (Jeffrey L. Carson, MD, Sara Bakhtary, MD, Claudia S. Cohn, MD, PhD, Brenda J. Grossman, MD, MPH, Gaurav K. Gupta, MD, PhD, Aaron S. Hess, MD, PhD, Jessica L. Jacobson, MD, Ryan A. Metcalf, MD, Colin H. Murphy, MD, Micah T. Prochaska, MD, Jay S. Raval, MD, Eric Salazar, MD, PhD, Nabiha H. Saifee, MD, PhD, Aaron A. R. Tobian, MD, PhD, Jonathan Waters, MD, Nicole D. Zantek, MD, PhD, and Monica B. Pagano, MD) and members appointed by professional national and international organizations: Lewis J. Kaplan, MD (Society of Critical Care Medicine), Jonathan Waters, MD (American Society of Anesthesiologists and Society for Advancement of Patient Blood Management), Yulia Lin, MD (American Society of Hematology), Erica M. Wood, MD (International Society of Blood Transfusion), Cynthia So-Osman, MD, PhD (European Hematology Association), Katerina Pavenski, MD (International Collaboration for Transfusion Medicine Guidelines), and Stacey Valentine, MD, MPH (Pediatric Critical Care Transfusion and Anemia Expertise Initiative/Pediatric Critical Care Blood Research Network). Specialties represented included pathologists and hematologists (most with subspecialty expertise in transfusion medicine), anesthesiologists, pediatricians (Simon J. Stanworth, MD, DPhil, and Stacey Valentine, MD, MPH), internists (Jeffrey L. Carson, MD, and Micah T. Prochaska, MD), and critical care medicine physicians and trauma and acute care surgeons (Lewis J. Kaplan, MD). Chairs: Jeffrey L. Carson, MD, Department of Medicine, Rutgers Robert Wood Johnson Medical School; Chair, AABB CTMC committee: Monica B. Pagano, MD, Department of Laboratory Medicine and Pathology, University of Washington; Simon J. Stanworth, MD, Department of Haematology, Oxford University Hospitals NHS Trust, NHSBT, and University of Oxford; Stacey Valentine, MD, Department of Pediatrics, UMASS Medical Center. Members: Sara Bakhtary, MD, Department of Laboratory Medicine, University of California–San Francisco, AABB CTMC member; Claudia S. Cohn, MD, PhD, Department of Laboratory Medicine and Pathology, University of Minnesota, AABB chief medical officer; Brenda J. Grossman, MD, MPH, Department of Pathology and Immunology, Washington University School of Medicine, AABB CTMC member; Gaurav K. Gupta, MD, PhD, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, AABB CTMC member; Aaron S. Hess, MD, PhD, Departments of Anesthesiology and Pathology and Laboratory Medicine, University of Wisconsin–Madison, AABB CTMC member; Jessica L. Jacobson, MD, Department of Pathology, New York University Grossman School of Medicine and NYC Health + Hospitals/Bellevue, AABB CTMC member; Lewis J. Kaplan, MD, Department of Surgery, Division of Trauma, Surgical Critical Care and Surgical Emergencies, Perelman School of Medicine, University of Pennsylvania, Society of Critical Care Medicine, representative; Yulia Lin, MD, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, American Society of Hematology, representative; Ryan A. Metcalf, MD, Department of Pathology, University of Utah, AABB CTMC member; Colin H. Murphy, MD, Pathology Associates of Albuquerque, Albuquerque, New Mexico, AABB CTMC member; Katerina Pavenski, MD, Department of Laboratory Medicine and Pathobiology, University of Toronto and St. Michael’s Hospital–Unity Health Toronto, International Collaboration for Transfusion Medicine Guidelines, representative; Micah T. Prochaska, MD, Department of Medicine, University of Chicago, AABB CTMC member; Jay S. Raval, MD, Department of Pathology, University of New Mexico, AABB CTMC member; Eric Salazar, MD, PhD, Department of Pathology and Laboratory Medicine, UT Health San Antonio, AABB CTMC member; Nabiha H. Saifee, MD, PhD, Department of Laboratory Medicine and Pathology, Seattle Children’s Hospital, AABB CTMC member; Aaron A. R. Tobian, MD, PhD, Department of Pathology, Johns Hopkins University, AABB president-elect; Cynthia So-Osman, MD, PhD, Department of Unit Transfusion Medicine (UTG), Sanquin Blood Bank, Amsterdam, the Netherlands, Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands, European Hematology Association SWG Transfusion, representative; Jonathan Waters, MD, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, American Society of Anesthesiologists, representative, Society for Advancement of Patient Blood Safety, representative, AABB CTMC member; Erica M. Wood, MD, Department of Haematology, Monash Health, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia, International Society of Blood Transfusion, representative; Nicole D. Zantek, MD, PhD, Department of Laboratory Medicine and Pathology, University of Minnesota, AABB CTMC member. Patient partner: Allan Dubon, MLS, ThermoFisher Scientific. Consultants: Gordon Guyatt, MD, Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University; Jane Dennis, PhD, Cochrane Injuries Group, London School of Hygiene and Tropical Medicine. AABB staff: Sharon Carayiannis, MT (ASCP)HP, vice president, Science and Practice; Ekaterina Torres, BS, meetings and awards manager.