More Blood Transfusions Linked to Increased Infections

Performing blood transfusions less often can reduce patient infection rates by about 20%, according to research published in the Journal of the American Medical Association.

Researchers performed a meta-analysis of 18 randomized trials including 7,593 hospitalized patients to evaluate whether red blood cell (RBC) transfusion thresholds are associated with the risk of infection and whether risk is independent of leukocyte reduction. They collected data from registers such as EMBASE, MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, International Clinical Trials Registry, and the International Standard Randomized Controlled Trial Number register through January 22, 2014. The researchers calculated pooled risk ratios and absolute risks of infection.

The investigators categorized blood transfusions into two parts, the majority of which are done when the blood work shows the concentration of RBCs at 9 or 10 g/dL, versus a restrictive approach where the hemoglobin levels are at approximately 7 or 8 g/dL.

“Many people are beginning to accept that we can make a difference — despite being taught in medical school that blood transfusions ‘might help and can’t hurt,’” Neil Blumberg, MD, co-author of the study, said in a press release. “What we’ve found is actually the opposite, that it can hurt and it rarely helps.”

Results showed that restrictive transfusions were associated with 18% reduction in infections such as pneumonia, wound infections, and sepsis. The researchers noted that each infection typically costs an extra $50,000 to treat, adding to the fact that most patients who get infections are already seriously ill.

“Among hospitalized patients, a restrictive RBC transfusion strategy was associated with a reduced risk of health care-associated infection compared with a liberal transfusion strategy,” the authors wrote. “Implementing restrictive strategies may have the potential to lower the incidence of health care-associated infection.”

“We must retrain medical staff to stop thinking of transfusion as a first resort,” Blumberg asserted.