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Credit: Elise Amendola
A review of randomized trials indicates that a restrictive approach to blood transfusion can decrease the risk of healthcare-associated infections (HAIs) for some patients.
Investigators found that, overall, restricting red blood cell (RBC) transfusions to patients with hemoglobin concentrations of 7 g/dL or less was associated with a lower incidence of HAIs such as pneumonia, mediastinitis, and sepsis.
However, when they stratified results by patient type, the researchers found that a restrictive transfusion approach significantly decreased the risk of HAIs only for patients who already had sepsis or were undergoing orthopedic surgery.
Jeffrey M. Rohde, MD, of the University of Michigan in Ann Arbor, and his colleagues reported these findings in JAMA.
The investigators set out to compare restrictive and liberal RBC transfusion strategies using data from 21 randomized trials in 9 countries. Eighteen of the trials (n=7593) contained enough information for a meta-analysis.
The pooled risk of all serious HAIs was 11.8% for patients treated with a restrictive transfusion approach and 16.9% for patients treated with a liberal approach. The risk ratio (RR) for the association between transfusion strategies and serious infection was 0.82.
“The fewer the red blood cell transfusions, the less likely hospitalized patients were to develop infections,” Dr Rohde said. “This is most likely due to the patient’s immune system reacting to donor blood [known as transfusion-associated immunomodulation].”
Even when the transfusions were leukoreduced, the risk of infection remained lower with a restrictive transfusion strategy. The RR was 0.80.
The results suggested that, for every 1000 patients in which RBC transfusion is a consideration, 26 could potentially be spared an HAI if restrictive strategies were used.
On the other hand, the investigators found no significant differences in the incidence of HAIs by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding, or for infants with low birth weight.
Yet the risk of infection was significantly lower with a restrictive strategy for patients who already had sepsis or were undergoing orthopedic surgery. The RRs were 0.51 and 0.70, respectively.
Dr Rohde and his colleagues said these results support AABB’s 2012 guidelines for transfusing hospitalized patients. The guidelines recommend a restrictive strategy for all hospitalized patients but also list specific hemoglobin-based recommendations for different patient populations. 
Credit: Elise Amendola
A review of randomized trials indicates that a restrictive approach to blood transfusion can decrease the risk of healthcare-associated infections (HAIs) for some patients.
Investigators found that, overall, restricting red blood cell (RBC) transfusions to patients with hemoglobin concentrations of 7 g/dL or less was associated with a lower incidence of HAIs such as pneumonia, mediastinitis, and sepsis.
However, when they stratified results by patient type, the researchers found that a restrictive transfusion approach significantly decreased the risk of HAIs only for patients who already had sepsis or were undergoing orthopedic surgery.
Jeffrey M. Rohde, MD, of the University of Michigan in Ann Arbor, and his colleagues reported these findings in JAMA.
The investigators set out to compare restrictive and liberal RBC transfusion strategies using data from 21 randomized trials in 9 countries. Eighteen of the trials (n=7593) contained enough information for a meta-analysis.
The pooled risk of all serious HAIs was 11.8% for patients treated with a restrictive transfusion approach and 16.9% for patients treated with a liberal approach. The risk ratio (RR) for the association between transfusion strategies and serious infection was 0.82.
“The fewer the red blood cell transfusions, the less likely hospitalized patients were to develop infections,” Dr Rohde said. “This is most likely due to the patient’s immune system reacting to donor blood [known as transfusion-associated immunomodulation].”
Even when the transfusions were leukoreduced, the risk of infection remained lower with a restrictive transfusion strategy. The RR was 0.80.
The results suggested that, for every 1000 patients in which RBC transfusion is a consideration, 26 could potentially be spared an HAI if restrictive strategies were used.
On the other hand, the investigators found no significant differences in the incidence of HAIs by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding, or for infants with low birth weight.
Yet the risk of infection was significantly lower with a restrictive strategy for patients who already had sepsis or were undergoing orthopedic surgery. The RRs were 0.51 and 0.70, respectively.
Dr Rohde and his colleagues said these results support AABB’s 2012 guidelines for transfusing hospitalized patients. The guidelines recommend a restrictive strategy for all hospitalized patients but also list specific hemoglobin-based recommendations for different patient populations.
Credit: Elise Amendola
A review of randomized trials indicates that a restrictive approach to blood transfusion can decrease the risk of healthcare-associated infections (HAIs) for some patients.
Investigators found that, overall, restricting red blood cell (RBC) transfusions to patients with hemoglobin concentrations of 7 g/dL or less was associated with a lower incidence of HAIs such as pneumonia, mediastinitis, and sepsis.
However, when they stratified results by patient type, the researchers found that a restrictive transfusion approach significantly decreased the risk of HAIs only for patients who already had sepsis or were undergoing orthopedic surgery.
Jeffrey M. Rohde, MD, of the University of Michigan in Ann Arbor, and his colleagues reported these findings in JAMA.
The investigators set out to compare restrictive and liberal RBC transfusion strategies using data from 21 randomized trials in 9 countries. Eighteen of the trials (n=7593) contained enough information for a meta-analysis.
The pooled risk of all serious HAIs was 11.8% for patients treated with a restrictive transfusion approach and 16.9% for patients treated with a liberal approach. The risk ratio (RR) for the association between transfusion strategies and serious infection was 0.82.
“The fewer the red blood cell transfusions, the less likely hospitalized patients were to develop infections,” Dr Rohde said. “This is most likely due to the patient’s immune system reacting to donor blood [known as transfusion-associated immunomodulation].”
Even when the transfusions were leukoreduced, the risk of infection remained lower with a restrictive transfusion strategy. The RR was 0.80.
The results suggested that, for every 1000 patients in which RBC transfusion is a consideration, 26 could potentially be spared an HAI if restrictive strategies were used.
On the other hand, the investigators found no significant differences in the incidence of HAIs by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding, or for infants with low birth weight.
Yet the risk of infection was significantly lower with a restrictive strategy for patients who already had sepsis or were undergoing orthopedic surgery. The RRs were 0.51 and 0.70, respectively.
Dr Rohde and his colleagues said these results support AABB’s 2012 guidelines for transfusing hospitalized patients. The guidelines recommend a restrictive strategy for all hospitalized patients but also list specific hemoglobin-based recommendations for different patient populations.