Objective  To investigate the clinical characteristics of patients with hemoglobin level higher than the recommended threshold by guidelines before receiving red blood cell (RBC) transfusion in non-surgical departments of Peking Union Medical College Hospital (PUMCH).

  Methods  One thousand patients were randomly selected from hospitalized patients who received RBC transfusion at PUMCH between January and December in 2013. Among them, those in non-surgical departments and with hemoglobin ≥ 70 g/L before transfusion were identified, and their hemoglobin level before RBC transfusion, proportion in non-surgical patients receiving RBC transfusion, symptoms and signs related to anemia before transfusion were described.

  Results  Of the 1000 patients, 270 were from non-surgical departments, and their average hemoglobin before RBC transfusion was (63.7±11.5)g/L. Seventy-four of the 270 (27.4%) patients had hemoglobin ≥ 70 g/L before RBC transfusion, including 60 (22.2%) patients with homoglobin ≥ 70 g/L and < 80 g/L, 10 (3.7%) patients with homoglobin ≥ 80 g/L and < 90 g/L, and 4 (1.5%) patients with hemoglobin ≥ 90 g/L. Among the 74 patients, symptoms and signs related to anemia and decision-making of the transfusion were identified in 59(79.7%) patients' medical records, the other 15(20.3%) patients with missing data were those with more severe conditions, multiple co-morbidities, multi-organ involvement, unstable conditions, or poor tolerance to decreasing hemoglobin level.

  Conclusions  The hemoglobin threshold for RBC transfusion in non-surgical departments of PUMCH was consistent with the recommendations of both international and Chinese guidelines. Given specific conditions, RBC transfusion in those patients with hemoglobin level higher than the recommended threshold is clinically appropriate, but the decision-making process regrading RBC transfusion should be recorded in detail.