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Blueprint Reduces Wasteful Blood Transfusions

By John Commins  
   November 20, 2017

Review of randomized clinical trials shows potential for harm and waste in unnecessary blood transfusions, which could be reduced by 40% to 65% under new guidelines.  

A study published this week in JAMA Internal Medicine endorses guidelines to reduce wasteful blood transfusions while improving patient safety and outcomes.

Researchers from Johns Hopkins, Cleveland Clinic and NYU Langone Medical Center compared liberal versus restrictive blood transfusions. Liberal transfusions are those given to patients with 9 to 10 grams of hemoglobin per one-tenth liter, or deciliter, of blood volume. Restrictive transfusions are those given to patients with 7 to 8 grams per deciliter.

Many of the clinical trials examined in the study used the number of patients who died within a 30- to 90-day window post-transfusion as a measure of patient outcome. Of the more than 8,000 patients included in eight clinical trials that were reviewed, there was no difference in mortality between liberal or restrictive transfusions.

One clinical trial found an increased mortality associated with liberal transfusion, and occurrence of blood clots was increased in the liberal cohort in a study that involved traumatic brain injury patients.

The researchers also found that the largest randomized trials reduced the amount of blood used by 40% to 65%.

 "In summary, there is no benefit in transfusing more blood than necessary and some clinical trials actually show harm to patients," said Steven Frank, MD, professor of anesthesiology at the Johns Hopkins University School of Medicine. "All this does is increase risks and cost without adding benefit."

The report also provides a how-to guide for launching a patient blood management program and offered these recommendations:

  • Stable adult patients, including critically ill patients, with hemoglobin levels of 7 g/dL or higher should not be transfused.
  • Patients undergoing orthopedic or cardiac surgery, or patients with underlying heart disease with hemoglobin levels of 8 g/dL or higher should not be transfused.
  • Patients who are stable and not actively bleeding should be transfused with a single unit of blood and then reassessed.

"These recommendations don’t apply to patients with acute coronary syndrome, severe thrombocytopenia and chronic dependent anemia, including sickle cell, because we didn't see enough evidence for patients with these conditions," Frank said.

John Commins is a senior editor at HealthLeaders.

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