Red blood cell transfusion in the elderly: the search for transfusion triggers

Over the past three decades, our knowledge regarding the optimal use of red blood cell transfusions has greatly expanded. The risk of contracting chronic viral infections has significantly decreased; elderly transfusion recipients are much more likely to experience harm from noninfectious complications of transfusion, particularly circulatory overload. The traditional goal of maintaining hemoglobin levels at 10 g/dl or greater has been abandoned in the face of increasing evidence favoring a more restrictive transfusion strategy targeting hemoglobin levels of 7–8 g/dl. We do not yet know the optimal transfusion strategy for all geriatric patients, and data addressing the transfusion needs of important patient subgroups is still quite limited.