ICU Blood Transfusions Used in Excess


A Cleveland Clinic study showed about 13% of its transfusions were in deference to current guidelines. That said, there's plenty of gray area for cause of care.

A new study from the Cleveland Clinic showed blood transfusions may have become an overused procedure in the intensive care unit (ICU).

Findings presented at the CHEST 2019 Annual Meeting in New Orleans this week show that, of 1009 ICU admissions resulting in at least 1 transfusion the Cleveland Clinic in 2015, approximately 13% were prescribed in deference to current transfusion guidelines.

Investigators believe this portion of transfusions could have possibly avoided altogether. The difference it could make to patients is improvements in clinical outcomes and cost-saving care.

The American Association of Blood Bank currently recommends transfusions are limited to patients at risk of shock, cardiovascular failure, circulatory collapse and decreased blood flow, or those who have a hemoglobin value below 7 g/dL.

Other organizations, including the Joint Commission on Accreditation of Healthcare Organizations, have already deemed blood transfusions as an overused procedure.

In an interview with MD Magazine® while at CHEST 2019, study author Sudhir Krishnan, MD, assistant professor at the Cleveland Clinic Lerner College of Medicine, described the 16-bed, 5000-annual patient ICU as among the biggest in the country.

He noted some patients to have received transfusions may have been near the 8 g/dL hemoglobin level—with indications the condition will worsen before it improves, driving the transfusion.

“We still have our work cut out for us, but on the whole, I’m reasonably pleased with the results we have,” Krishnan said. “We showed a mortality difference in patients transfused around the threshold of 7 (g/dL), and if it is unwarranted, we know there’s a higher mortality in those patients.”

In the following months, investigators will look into the “compulsions that guided these unnecessary transfusions,” Krishnan said. However, only about 10% of all observed cases showed actual deviation from published guidelines—in a facility burdened with severe conditions.

“One-third of our patients are mechanically ventilated, one-third of our patients are in septic shock, more than one-third have liver disease or are auto-immunosuppressed,” Krishnan explained. “It is a very sick ICU.”

That said, there is likely room for improvement when considering the resource value of a transfusion.

“Blood is an expensive resource. It’s a limited resource,” Krishnan said. “It’s tough to procure, and it’s tough to treat.”

The study, “Adherence to Blood Product Transfusion Guidelines: An Observational Study of the Current Transfusion Practice in a Medical ICU,” was presented at CHEST 2019.

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