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Convincing evidence supports a restrictive transfusion threshold — hemoglobin, <7 g/dL — for most critically ill patients (NEJM JW Gen Med Mar 1 1999 and N Engl J Med 1999; 340:409; NEJM JW Gen Med Nov 1 2014 and N Engl J Med 2014; 371:1381). However, oncology patients have been poorly represented in previous trials. In this single-center study from Brazil, investigators randomized 300 adults with solid-organ malignancies and septic shock to either a restrictive (hemoglobin, <7 g/dL) or a liberal (hemoglobin, <9 g/dL) transfusion strategy. In 60% of patients, the source of sepsis was pneumonia. Transfusions were performed in 61% of patients in the liberal group and in 41% of patients in the restrictive group.
At 28 days, mortality was 45% in…