Buffmire Lecture Outlines Best Practices for Red Blood Cell Transfusion in High-Risk Clinical Settings

December 4, the University of Arizona College of Medicine – Phoenix welcomed Jeffrey L. Carson, MD, MACP — Provost, New Brunswick Campus of Rutgers Biomedical and Health Sciences at Rutgers University, NJ — as the Flinn Foundation’s 2025 Buffmire Lecture speaker.

“Dr. Carson is a nationally renowned clinical trialist in transfusion medicine. When any of us are considering a blood transfusion for our patients and open the literature, we would undoubtedly land on his trial data,” said Ranita Sharma, MD, executive vice dean of the College of Medicine – Phoenix.

A board-certified internist who practices office and hospital-based internal medicine, Dr. Carson is an expert in bloodless and transfusion medicine. His talk —Transfusion in High-Risk Clinical Settings: Heart, Brain and the Gut — explored his years of research and that of other groups, when determining the risk-benefit thresholds for blood transfusions in various clinical scenarios. Earlier in the day, he presented Red Blood Cell Transfusion in Cardiac Patients: How Low Can You Go? at a multidisciplinary Grand Rounds held in the Banner – University Medical Center Phoenix Amphitheater.

Logically one would assume that a transfusion would always be the safer option for a patient with low hemoglobin levels, but the research does not always reflect that. Depending on the organ, a clinician’s approach to RBC transfusions may vary. For example, in patients with pre-existing cardiovascular disease (CVD), the lower the pre-operative hemoglobin, the higher the odds of death for the patient. For those with CVD, mortality and morbidity rise as hemoglobin falls, and human data suggest these patients are less equipped to handle the consequences of anemia.

Most clinical trials suggest that use of restrictive transfusion strategy that withholds transfusion until the hemoglobin concentration is less than 7 to 8 g/dL is safe. However, Dr. Carson presented the results of the recently published trial MINT — which he led — that suggested greater risk of death or recurrent myocardial infarction (MI) using a restrictive strategy. His clinical conclusions — summarized in the New England Journal — stated that a liberal transfusion strategy may be the most prudent approach to transfusion in anemic patients with an MI. In contrast, “Transfusion practice in patients with pre-existing cardiovascular disease, I would argue, requires more research,” he added.

New trial data and meta-analysis suggests that patients with acute brain injury may also benefit from use of higher transfusion threshold of 10 g/dL. In cases where a patient was suffering from a traumatic brain injury, patients treated with liberal transfusionstrategy of 9-10 g/dL had better neurological recovery at six months.

A key takehome message emphasized at the end of Dr. Carson’s talk was that “Transfusion decisions should not be based purely on hemglobin level but also symptoms, signs, co-morbidity and patients preferences.”

Dr.Carson is funded by the National Heart, Lung and Blood Institute at the National Institutes of Health.

In partnership with the Flinn Foundation, the college hosts the Buffmire Lecture series to bring national leaders in the science and art of medicine to Arizona to share their expertise with students, residents, clinicians, faculty and partners to improve health care for the communities we serve.

The lectureship is named for Donald K. Buffmire, MD, in recognition of his distinguished career as a medical practitioner in Arizona and his leadership role with the Flinn Foundation in supporting the College of Medicine – Phoenix.