The restrictive strategy, both in patients with chronic anemia and in those with anemia in the absence of acute coronary syndrome or active major bleeding, including patients hospitalized with onco-haematological pathologies, consists in the transfusion of concentrated RBCs at hemoglobin (Hb) levels lower than 7 g/dl with a target Hb after transfusion between 7 and 9 g/dl. Higher Hb thresholds should be reserved for patients with: marked acute coronary syndrome, decrease in tissue oxygenation, such as critically ill patients, chronic heart disease or candidates to cardiac surgery or orthopedic interventions. Priority should be given to the clinical evaluation and the etiology of the anemia, considering the possibility of transfusing single units of red blood cells. Overuse of packed red blood cell transfusion is burdened by increased risk of adverse effects (such as allergic reactions, hemolysis, sepsis, anaphylaxis, acute lung injury related to transfusion, fluid overload), increased mortality and morbidity in critically ill patients and increased healthcare costs. Clinical trials have shown that the restrictive strategy does not lead to increased mortality and morbidity in hospitalized patient cases.

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