Study: Overuse of transfusions problematic in all but the most traumatic surgeries

Transfusion methods vary wildly between surgeons and many patients receiving these transfusions are not improving or can even be worse off from a blood transfusion performed prematurely, according to a study by Johns Hopkins researchers.

The 18-month study of hospital anesthesia records, which was published in Anesthesiology, showed 2,981 patients (6.2%) of more than 48,000 patients admitted during the study period received a variety of transfusions that did not correlate with how sick they were or with how much blood they lost during surgery, according to a Johns Hopkins University School of Medicine press release.

Surgeries for orthopedic-related issues, pancreatic cancer and aortic aneurysms had transfusion trigger points above 10 g/dL, while cardiac-related surgeries had much lower trigger points. Several transfusion guidelines state that surgeons should infuse blood when a patient’s hemoglobin level falls below 6 g/dL to 7 g/dL and not transfuse when the hemoglobin level is above 10 g/dL. But these guidelines are unclear about what to do when levels fall between those limits, according to the release.

“Over the past 5 years, studies have supported giving up less blood than we used to and our research shows that practitioners have not caught up,” Stephen M. Frank, MD, lead study author and associate professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine, stated in the release. “Blood conservation is one of the few areas in medicine where outcomes can be improved, risk reduced and costs saved all at the same time. Nothing says it is better to give a patient more blood than is needed.”

Frank recommended surgeons and anesthesiologists discuss transfusion triggers preoperatively. He stated that decreasing the number of transfusions would not only prevent unnecessary patient complications but also decrease costs, since transportation and storage costs for Red Cross blood can be up to $1,100 per unit, as noted in the release.

Although surgeons should generally decrease the number of transfusions performed, the exceptions are traumatic or hemorrhagic surgeries where infusing extra blood could be lifesaving, Frank stated.

Reference:

Frank SM, Savage WJ, Rothschild JA, et al. Variability in blood and blood component utilization as assessed by an anesthesia information management system. Anesthesiology. Published online before print April 23, 2012. doi:10.1097/ALN.0b013e318255e550.