A recent study suggests that there is substantial variation in blood transfusion practices.[1]
Dr. Steven Frank and colleagues at Johns Hopkins Hospital examined anesthesia records for more than 48,000 patients. They evaluated hemoglobin threshold values which triggered transfusion by different surgeons and anesthesiologists.
They found that, while some surgical services were conservative in their blood use, other physicians consistently transfused at higher trigger points, often at or above 10 grams per deciliter.
Potential overuse of transfusions can be wasteful, as blood is a scarce and expensive resource. Plus, unnecessary transfusions come with additional risks and may not result in improved outcomes.
One of the reasons for the variation in transfusion practices has been the lack of clear guidelines on when patients should be transfused.
AABB, the global leader in advancing the practice and standards of transfusion medicine and cellular therapies, recently issued new guidelines based on recommendations by an expert panel.
The panel reviewed nineteen clinical trials, involving more than 6000 patients.
The patients included higher-risk individuals, such as the elderly and those with cardiovascular conditions.[2]
Dr. Jeffrey Carson, who is Chief of the Division of General Internal Medicine at the University of Medicine and Dentistry at New Jersey and also led the panel, notes,
(Audio Quote)
“There was a very consistent set of findings. And that was that less blood, or what we call restrictive transfusion, did not harm patients. And yet there was no evidence that using more blood or liberal transfusion improved outcomes.”
“If you can’t show that more blood improves outcome, why would you use it?”
Based on the reviewed data, the panel suggested four guidelines:
For most hospitalized, stable patients, transfusions should be considered when hemoglobin levels fall below 7 to 8 grams per deciliter.
Patients with preexisting cardiovascular disease, should be considered for transfusion when they have symptoms or hemoglobin levels of 8 grams per deciliter or lower.
Recommendations are not specified for transfusing hospitalized, hemodynamically stable patients with acute coronary syndrome because of uncertain, low-quality evidence.
Transfusion decisions should incorporate symptoms of the patients as well as hemoglobin thresholds.
These new evidence-based guidelines will hopefully help reduce unnecessary transfusions and help improve patient outcomes.
That’s all for this edition of Transfusion News. Be sure to check out another edition of Transfusion News featuring news from the recent PLADO study available now at transfusionnews.com.
References:
1. Frank SM, Savage WJ, Rothschild JA, Rivers RJ, Ness PM, Paul SL, Ulatowski JA. Variability in Blood and Blood Component Utilization as Assessed by an Anesthesia Information Management System. Anesthesiology 2012;117: 99-106.
2. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, Holcomb JB, Illoh O, Kaplan LJ, Katz LM, Rao SV, Roback JD, Shander A, Tobian AA, Weinstein R, Swinton McLaughlin LG, Djulbegovic B. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB*. Ann Intern Med 2012;157: 49-58.
