Erythrocyte transfusion, used as both a prophylactic and therapeutic intervention, is a cellular transplantation that comes with consequent sequelae including immediate1–3  and long-term engraftment of donor leukocytes in the recipient, and other immunologic adversities. It is, therefore, incumbent upon clinicians to identify when erythrocyte transfusion is indicated. This issue of Anesthesiology contains an important publication by Zeroual et al. that investigates the consequence of increasing the restrictiveness of transfusion guidelines.

Non–actively bleeding postcardiac surgery patients in the intensive care unit (ICU) in whom hemoglobin concentration fell to less than 9 g/dl were randomly allocated by Zeroual et al. to either standard-of-care erythrocyte transfusion or to an experimental arm in which individuals would be transfused only if their hemoglobin was less than 9 g/dl and their superior vena cava oxyhemoglobin saturation (which does not include...

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