Questions · Restrictive versus Liberal Transfusion Thresholds
10 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
A patient-level meta-analysis pooled 4,311 patients, including those from the MINT trial, comparing restrictive with liberal transfusion in myocardial infarction. State what restrictive transfusion produced for cardiac death at 30 days, giving both rates, and for all-cause mortality at 6 months.
Answer: Restrictive transfusion in myocardial infarction gave more cardiac death at 30 days, 5.5% versus 3.7%, and higher all-cause mortality at 6 months.
Myocardial infarction is the setting where the restrictive habit turns against you: more cardiac death at 30 days and higher all-cause mortality at 6 months in this pooled patient-level analysis.
Source claim: Pooling 4,311 patients including MINT, restrictive transfusion in myocardial infarction gave more cardiac death at 30 days (5.5% versus 3.7%) and higher all-cause mortality at 6 months.
Restrictive versus Liberal Transfusion in Myocardial Infarction — A Patient-Level Meta-Analysis, NEJM evidence 2025
recall · CA-2 · phrased by llm
In the TRICC trial, critically ill patients were transfused for a haemoglobin below 7 g/dL or below 10 g/dL. State the trial's conclusion about the lower threshold, what was seen for in-hospital mortality, and which patient groups were flagged as a possible exception.
Answer: TRICC concluded that transfusing at a haemoglobin below 7 g/dL was at least as effective as below 10 g/dL in critically ill patients, with lower in-hospital mortality, with the possible exception of acute myocardial infarction and unstable angina.
TRICC is where the restrictive threshold came from, and note that it carved out the possible exception of acute myocardial infarction and unstable angina from the very beginning.
Source claim: In TRICC, transfusing at a haemoglobin below 7 g/dL was at least as effective as below 10 g/dL in critically ill patients, with lower in-hospital mortality and the possible exception of acute myocardial infarction and unstable angina.
A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care, The New England journal of medicine 1999
recall · CA-2 · phrased by llm
For hospitalised patients with acute myocardial infarction, state the transfusion strategy and haemoglobin threshold suggested by the AABB international clinical practice guideline, and what that guideline notes about a restrictive 7-8 g/dL threshold in this group.
Answer: For hospitalised patients with acute myocardial infarction the AABB guideline suggests a liberal strategy below 10 g/dL, noting that a restrictive 7-8 g/dL threshold may increase mortality in this group.
Acute myocardial infarction is the named exception in the AABB guideline: a liberal strategy below 10 g/dL, because the restrictive 7-8 g/dL threshold may increase mortality here.
Source claim: For hospitalised patients with acute myocardial infarction the AABB guideline suggests a liberal strategy below 10 g/dL, noting a restrictive 7-8 g/dL threshold may increase mortality in this group.
Red Cell Transfusion in Acute Myocardial Infarction: AABB International Clinical Practice Guidelines, Annals of internal medicine 2025
recall · CA-1 · phrased by llm
A resident proposes adopting a single haemoglobin trigger for every non-bleeding ICU patient for the whole admission. According to a narrative review of the physiological determinants of transfusion decision-making in non-bleeding critically ill patients, state the two limitations of that approach and the current status of the proposed bedside alternatives.
Answer: Haemoglobin alone does not reflect tissue oxygenation, and a single threshold across an ICU stay prevents neither unnecessary nor insufficient transfusion; central venous oxygen saturation and oxygen extraction ratio are bedside alternatives that are still under study rather than established replacements.
A haemoglobin number is not a measure of tissue oxygenation, and one fixed trigger for a whole ICU stay will both over- and under-transfuse, which is why physiologic markers like ScvO2 and oxygen extraction ratio are being studied.
Source claim: Haemoglobin alone does not reflect tissue oxygenation, and a single threshold across an ICU stay prevents neither unnecessary nor insufficient transfusion; central venous oxygen saturation and oxygen extraction ratio are bedside alternatives under study.
Physiological Determinants and the Red Blood Cells Transfusion Decision-Making Process in Non-Bleeding Critically Ill Patients: A Comprehensive Narrative Review, Intensive care medicine 2026
recall · CA-3 · phrased by llm
In FOCUS, a ___ g/dL threshold after hip fracture surgery in patients at cardiovascular risk gave no better survival or independent walking at 60 days than transfusing at 8 g/dL or for symptoms.
Answer: 10
In FOCUS, a 10 g/dL threshold after hip fracture surgery in patients at cardiovascular risk gave no better survival or independent walking at 60 days than transfusing at 8 g/dL or for symptoms.
Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery · PMID 22168590
recall · CA-2 · phrased by derived
Transfusing patients whose oxygen extraction ratio exceeded 0.30 improved that ratio and central venous oxygen saturation, while those at or below ___ gained no physiological benefit.
Answer: 0.30
Transfusing patients whose oxygen extraction ratio exceeded 0.30 improved that ratio and central venous oxygen saturation, while those at or below 0.30 gained no physiological benefit.
Red Blood Cell Transfusion in the Intensive Care Unit · PMID 40134137
recall · CA-2 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.