3 practices to reduce excessive blood transfusions

After reviewing data compiled on blood transfusions from a pool of randomized clinical trials, researchers with Baltimore-based Johns Hopkins Medicine, Cleveland Clinic and New York City-based NYU Langone Medical Center endorsed blood transfusion recommendations that reduce blood use to improve patient safety and care outcomes, according to an article published in JAMA Internal Medicine.

Researchers examined eight clinical trials highlighting either liberal or restrictive blood transfusion practices. Researchers identified no significant difference in mortality between the two transfusion practices among the 8,000 total participants collectively included in the trials. However, one clinical trial identified increased mortality related to liberal transfusion practices. In another trial involving traumatic brain injury patients, the occurrence of blood clots increased among the liberal transfusion cohort. 

"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 and one of the article's authors. "All this does is increase risks and cost without adding benefit."

Researchers endorsed the following recommendations for blood transfusions:

  • Adult patients with hemoglobin levels of 7 grams per deciliter or higher should not be transfused.
  • Orthopedic and cardiac surgery patients, or patients with underlying heart disease, displaying hemoglobin levels of 8 grams per deciliter or higher should not be transfused.
  • Stable patients with no active bleeding should be transfused with a single unit of blood and then reassessed.

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