Blood transfusion study: Less is more

Aug 05, 2009

A new study suggests that blood transfusions for hospitalized cardiac patients should be a last resort because they double the risk of infection and increase by four times the risk of death.

The analysis of nearly 25,000 Medicare patients in Michigan also showed that transfusion practices after heart surgery varied substantially among hospitals, a red flag that plays into the health care reform debate.

A wide variation in care is a hot-button issue, as lawmakers and health reform experts discuss the best ways to address the variations. Some experts believe the country needs a system of medical guidelines, supported by scientific evidence, to aid doctors in decision-making. In fact, the Institute of Medicine has called for a national initiative of comparing the benefits and harms of certain methods to improve the delivery of care -- an effort referred to by health-care insiders as "comparative effectiveness" research.

Blood transfusion is an area that could be well served with stronger, research-based guidelines, since the current clinical practice is all over the map, said study co-author Neil Blumberg, M.D., professor of Pathology and Laboratory Medicine and director of Transfusion Medicine at the University of Rochester Medical Center.

"Doctors are simply doing what they were trained to do, but it turns out that their actions are more harmful than helpful in many cases," Blumberg said. "This is an instance in which clinical practice got way ahead of research. And changing the liberal use of transfusions is going to be difficult despite the evidence showing it is usually not essential."

The study was published July 31, 2009 in the journal, BMC Medicine. It was designed to assess patient outcomes as well as hospital variation in blood use.

Blumberg and lead author Mary Rogers, Ph.D., of the University of Michigan Health System, analyzed patient records in 40 hospitals, from admission to 30 days after discharge. All had received coronary artery bypass graft surgery from 2003 to 2006. They found that 30 percent of variation in transfusion practices seemed to be due to widely varied practices among hospital sites.

Also, blood use among women patients ranged from 72.5 percent to 100 percent, and blood use among men varied from about 50 percent to 100 percent. Transfusions with donor blood were associated with infections of the genitourinary system, respiratory tract, bloodstream, digestive tract and skin, the study said.

The risk of death in the hospital was nearly 5 times greater among patients who received a blood transfusion, and the risk of death in the next 30 days was nearly three times greater. Some of the risk may've been due to the underlying condition that led to transfusion but an increasingly convincing body of evidence demonstrates that some of the effect is almost certainly due to the transfusion itself, Blumberg said.

Blood transfusions are extremely common in the United States. Some of the typical reasons for transfusions include prevention of anemia and improving oxygen delivery in heart failure.

Blumberg has been a long-time advocate for fewer transfusions and, when they are necessary, for using blood from which the donor's white cells have been removed. This process, called leukoreduction, is believed to diminish the chances of infection and inflammation, research has shown.

"Blood transfusions are certainly necessary in life-threatening situations," Blumberg said. "But this study and other studies confirm they should be a last resort, not a first resort, as they often are."

For decades the URMC has been a leader in the study of blood transfusions, and Strong Memorial Hospital at URMC was among the first in the country to begin using leukoreduced blood for all its patients.

More recently, a team at Strong began to further refine the guidelines for . As a result the hospital has already seen a 10 to 15 percent drop in transfusions during the past six months. The improvement program is still in its early stages, and Blumberg said they will closely monitor the use of transfusions at Strong in the coming months.

Source: University of Rochester Medical Center (news : web)

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

Blood transfusions associated with infection

Jul 31, 2009

A study of almost 25,000 coronary artery bypass graft (CABG) patients has shown that receiving blood from another person is associated with a two-fold increase in post-operative infection rates. The research, published in ...

Transfusion expert urges wider use of filtered blood

Apr 03, 2007

Filtering white cells from donor blood before a transfusion is much safer for patients and long overdue as a national standard for all surgical procedures, according to University of Rochester researchers who present their ...

Young blood fights cancer

Dec 30, 2008

"New blood" can revitalize a company or a sports team. Recent research by Tel Aviv University finds that young blood does a body good as well, especially when it comes to fighting cancer.

Recommended for you

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

mvg
not rated yet Aug 05, 2009
Do you suppose Jehovah's Witnesses have been right about blood transfusions all along?

More news stories

Vietnam battles fatal measles outbreak

Vietnam is scrambling to contain a deadly outbreak of measles that has killed more than 100 people, mostly young children, and infected thousands more this year, the government said Friday.

Continents may be a key feature of Super-Earths

Huge Earth-like planets that have both continents and oceans may be better at harboring extraterrestrial life than those that are water-only worlds. A new study gives hope for the possibility that many super-Earth ...

Researchers successfully clone adult human stem cells

(Phys.org) —An international team of researchers, led by Robert Lanza, of Advanced Cell Technology, has announced that they have performed the first successful cloning of adult human skin cells into stem ...

Under some LED bulbs whites aren't 'whiter than white'

For years, companies have been adding whiteners to laundry detergent, paints, plastics, paper and fabrics to make whites look "whiter than white," but now, with a switch away from incandescent and fluorescent lighting, different ...