Blood transfusions are one of the most common medical procedures in hospitalized patients, and robust data from randomized clinical trials support the safety and efficacy of restrictive red blood cell (RBC) transfusion thresholds. Previous studies in the U.S. suggest that RBC transfusions started declining in 2008. A recent study published in Blood Advances suggests that RBC and plasma transfusions continued to decline through 2018. Based on nationally-representative data from the National Inpatient Sample collected between the end of 2015 and 2018, the percentage of RBC transfusions in hospitalized patients decreased from 4.22% in 2015 to 3.79% in 2018 (Ptrend=0.008). Plasma transfusions showed a similar decrease while platelet transfusions remained stable during this same time. However, cryoprecipitate use increased from 0.07% in 2015 to 0.08% in 2018 ((Ptrend=0.006) suggesting a widening recognition of hypofibrinogenemia management for patients at increased risk of hemorrhage. Declines in RBC use were universal across sex, race, and patient type; however, significant RBC transfusion changes were only seen in patients 50 years and older—not pediatric patients (<18 years old) nor those 18 to 49 years. Data from yearly National Blood Collection Utilization Survey confirms an overall decrease in transfusions through 2017, and also suggests that the utilization of RBCs in the U.S. may have reached a nadir.
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