Management of bleeding following major trauma: is a target haemoglobin of 7 to 9 g/dl high enough?

recommend a target haemoglobin of 7 to 9 g/dl to initiate blood transfusion [1]. In their rationale the authors use a subgroup of trauma patients from the Transfusion Require ments in Critical Care study; however, patients with active blood loss were excluded from this trial. Expressing a current opinion about transfusion and trauma patients, in 2006 McIntyre and Hebert wrote: 'It is important to put RBC [red blood cell] transfusions into the context of three main time frames, i.e. prehospital care, initial 24–48 h after admission to hospital and there after, because each frame has its own set of circumstances which may dictate the need for diff erent timing, volume and rapidity of transfusions' [2]. To our knowledge , the only trial to evaluate a target haemoglobin in shock involved early goal-directed therapy in septic shock [3]. Th e early goal-directed therapy protocol included maintain ing a haematocrit of 30% (haemoglobin at 10 g/dl). In the results, the early goal-directed therapy group had a signifi cantly higher haematocrit than the control group and also received more transfusions. Raising the target haemoglobin to 10 g/dl has two interest ing eff ects: haemodilution is reduced, harmful in the present case; and the transfusion delay is decreased. Riskin and colleagues showed that reducing the transfusion delay may decrease the mortality rate [4]. For the fi rst time, three studies suggest that transfusion may be associated with a reduced mortality rate [5]. Th e real benefi cial eff ect of blood transfusion is probably that it gives time to stop the bleeding. Competing interests The authors declare that they have no competing interests. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. Massive transfusion protocols: the role of aggressive resuscitation versus product ratio in mortality reduction.