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my personal edition > transfusion > news
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DGNews
Blood Transfusions Should Be a Last Resort in Cardiac Patients, Study Suggests
ROCHESTER, NY -- August 5, 2009 -- A new study suggests that blood transfusions for hospitalised cardiac patients should be a last resort because they double the risk of infection and increase the risk of death by 4 times..
The analysis of nearly 25,000 Medicare patients in Michigan also showed that transfusion practices after heart surgery varied substantially among hospitals.
The study, published July 31 in the journal, BMC Medicine, was designed to assess patient outcomes as well as hospital variation in blood use.
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, MD, Pathology and Laboratory Medicine, and Transfusion Medicine, 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," said Dr. Blumberg. "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."
Dr. Blumberg, lead author Mary Rogers, PhD, University of Michigan Health System, Detroit, Michigan, and colleagues analysed patient records in 40 hospitals, from admission to 30 days after discharge. All had received coronary artery bypass graft surgery from 2003 to 2006.
Transfusions with donor blood were associated with infections of the genitourinary system, respiratory tract, bloodstream, digestive tract, and skin.
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 3 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.
They found that 30% 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% to 100%, and blood use among men varied from about 50% to 100%.
"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."
SOURCE: University of Rochester Medical Center
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