Three similar studies have been published recently on this topic: one in France, one in the Netherlands and one in Canada. Overall, a restrictive transfusion trigger appears to have been adopted, perhaps more so in North America than in Europe, possibly because of the considerable impact of the TRICC trial on transfusion practice on this side of the Atlantic. As mentioned by the authors, overtransfusion is related to either ignorance of published information or to the reluctance of some clinicians (mainly in the surgical context) to adopt lower transfusion thresholds depite the results of well-conducted randomized clinical trials. Moderate anemia is well tolerated, even in older patients, and the systematic overtransfusion of patients, with its associated risks, has become unacceptable.

– Jean-François Hardy