In a hypotensive patient with a high lactate, blood can feel like the obvious fix, especially when haemoglobin is 8 g/dL and the patient has cancer, kidney disease or is elderly.
Unless there is active bleeding or acute myocardial ischaemia, a threshold of 7 g/dL is supported across septic shock trials, and a higher threshold has not improved lactate or survival. Each unit carries risks of volume overload, transfusion reactions and, as recent data suggest, thrombosis.
Before requesting blood, write the haemoglobin and the indication in the notes. That short pause prevents most unnecessary transfusions.
- Transfuse in septic shock when haemoglobin falls below 7 g/dL
- Make exceptions for active bleeding or acute coronary ischaemia
- Do not transfuse to treat a raised lactate alone
- Record the haemoglobin and indication before each unit
Why it matters
A higher transfusion threshold adds risk without improving recovery from shock.
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