UMEM Educational Pearls

Hemoglobin Threshold in Septic Shock

  • Numerous trials have demonstrated the benefit of lower hemoglobin thresholds for blood transfusion in critically ill patients.
  • The recently published Transfusion Requirements in Septic Shock (TRISS) trial evaluated the effects on mortality of a lower versus higher hemoglobin threshold in ICU patients with septic shock.
  • The TRISS trial randomized 1005 patients to a lower hemglobin threshold (7 g/dL) or a higher hemoglobin threshold (9 g/dL). 
  • Overall, there was no difference in 90-day mortality between groups.
  • Patients randomized to the lower threshold received significantly fewer units without any increase in ischemic or adverse events.
  • Take Home Point: A hemoglogin threshold of 7 g/dL for blood transfusion appears effective for most patients with septic shock.


Holst LB, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. NEJM 2014; [published online]