From the Journals

Blood transfusions are dropping in U.S. hospitals



The number of red blood cell (RBC) and plasma transfusions conducted in U.S. hospitals has declined steadily since 2011, perhaps as a result of hospitals instituting new blood management programs after randomized trials showed the safety of restrictive transfusion strategies.

There has been no change in the frequency of platelet transfusions since 2011.

The researchers analyzed data from the National Inpatient Sample, using ICD-9-CM procedure codes to identify transfusion procedures. They examined the percentage of hospitalizations with one or more RBC transfusions, since these represent the majority of transfusions. Secondary outcomes included hospitalizations with one or more plasma or one or more platelet transfusions. The findings were published in a research letter in JAMA.

The study included data from the period of 1993-2014. The frequency of transfusions has trended upward since 1993, but a joinpoint analysis found an inflection point at 2011. The researchers then focused their analysis on the period from 2011 to 2014.

Blood bags Vlad/Fotolia
RBC transfusions occurred in 6.8% of hospitalizations in 2011 and dropped to 5.7% in 2014 (adjusted risk ratio [aRR], 0.83; 95% confidence interval, 0.78-0.88). The frequency of plasma transfusions dipped from 1.0% to 0.87% (aRR, 0.87; 95% CI, 0.80-0.95). There was no significant change in the frequency of platelet transfusions (aRR, 0.99; 95% CI, 0.89-1.10), an area in which there is little evidence to guide clinical practice.

The researchers found reductions in RBC transfusions among all sexes, race/ethnicities, patient risk severities, payer types, and admission types. They found no statistically significant reductions in RBC transfusions in private investor–owned hospitals or in patients under the age of 18, though they noted that there is limited evidence to guide clinical practice in the pediatric population.

The decline in RBC transfusions was greater for elective admissions (aRR, 0.74, 95% CI, 0.67-0.80) than it was for nonelective admissions (aRR, 0.86; 95% CI, 0.81-0.91; P for interaction less than .001).

“The observed decreases in RBC and plasma transfusions from 2011 to 2014 may reflect evidence demonstrating the safety of restricting RBC transfusions, patient blood management programs, conservation initiatives (e.g., cell salvage, pharmacotherapy, improved surgical techniques), advocacy from medical organizations, and publication of transfusion guidelines,” the researchers wrote.

The study is limited by its retrospective design and may not be generalizable to outpatient settings.

The study was supported by grants from the National Institutes of Health and Weill Cornell Medical College. Two of the study authors reported personal fees from Terumo BCT, Haemonetics, and Octapharma. No other disclosures were reported.

SOURCE: Goel R et al. JAMA. 2018 Feb 27;319(8):825-7.

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