Liberal RBC Transfusions Do Not Increase Mortality

It has been hypothesized that blood transfusions may lead to increased risk of subsequent infections, cancer, and possibly death. The FOCUS trial was a multi-center, randomized, controlled trial that enrolled more than 2,000 patients over 50 years-old who underwent surgery to repair a hip fracture and who were at risk or had a history of cardiovascular disease.

Patients were randomly assigned to either receive liberal RBC transfusions (to maintain hemoglobin >100 g/L) or restrictive RBC transfusions (hemoglobin >80 g/L or anemia symptoms); baseline characteristics were similar in both groups. The original trial previously showed a restrictive RBC transfusion strategy is as safe as a liberal transfusion strategy. In a secondary analysis, recently published in The Lancet, the long-term effects of liberal verses restrictive transfusions were evaluated. Patients had a median follow-up period of 3.1 years. Mortality did not significantly differ between patients receiving liberal transfusions verses those in the restrictive transfusion group. Moreover, the causes of death from cardiovascular disease, cancer and infections were nearly identical in both groups.

References

1. Carson JL, Sieber F, Cook DR, Hoover DR, Noveck H, Chaitman BR, Fleisher L, Beaupre L, Macaulay W, Rads GG, Paris B, Zagorin A, Sanders DW, Zakriya KJ, Magaziner J. Liberal versus restrictive blood transfusion strategy: 3-year survival and cause of death results from the FOCUS randomised controlled trial. The Lancet 2014; in press.
2. Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, Nemo G, Dragert K, Beaupre L, Hildebrand K, Macaulay W, Lewis C, Cook DR, Dobbin G, Zakriya KJ, Apple FS, Horney RA, Magaziner J, Investigators F. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011;365: 2453-62.