Fewer blood transfusions reduce hospital infections

Red blood cell (RBC) transfusion strategies are a common treatment in the U.S., but infection rates dropped by 20 percent when hospitals performed them less often, information that could help save hospitals money on infection-related costs, according to a study published in the Journal of the American Medical Association.

Researchers from the University of Michigan and Neil Blumberg, M.D., of the University of Rochester School of Medicine and Dentistry, studied 18 randomized clinical trials with restrictive versus liberal RBC transfusion strategies that contained a total of 7,593 patients. They found that incidence of healthcare-associated infections such as pneumonia, mediastinitis, wound infections and sepsis was 11.8 percent in the restrictive group and 16.9 percent in the liberal group, according to the study.

Most trials define a restrictive transfusion strategy as the administration of RBCs once hemoglobin falls below either 7 or 8 g/dL, and most trials define a liberal strategy as the administration of RBCs once hemoglobin level falls below 10 g/dL, according to an accompanying article in JAMA.

The risk ratio for the association between transfusion strategies and serious infection was .82, and the number needed to treat within restrictive strategies was 38 patients, according to the study. Infection risk remained low within restrictive strategies, even with leukocyte reduction. Risk ratio was .70 among orthopedic surgery patients and .51 for sepsis patients.

However, there were no significant differences in the incidence of infection by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding or infants with low birth weight, researchers found. Restrictive RBC transfusion strategies have helped hospitals lower incidence of healthcare-associated infections, the study concluded.

"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,'" Blumberg told HealthCanal. "What we've found is actually the opposite, that it can hurt and it rarely helps."

Each infection typically requires an extra $50,000 to treat, and many infected patients are already seriously ill, Blumberg said.

To learn more:
- here's the study
- read the opinion piece 
- check out the HealthCanal piece

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