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Limiting blood transfusions for moderate anemia safe

In recent years, the prevalence of moderate anemia after hospitalization has increased while red blood cell transfusions have decreased, but morbidity, mortality and rehospitalization have not been adversely affected, according to findings published in Annals of Internal Medicine.

Other researchers argued that the study design limits the applicability and clinical value of the reported results.

“Randomized clinical trial findings support decreased red blood cell (RBC) transfusion and short-term tolerance of in-hospital anemia,” Nareg H. Roubinian, MD, MPHTM, from Kaiser Permanente Northern California, Blood Systems Research Institute and University of California, San Francisco, and colleagues wrote. “However, long-term outcomes related to changes in transfusion practice have not been described.”

Roubinian and colleagues conducted a retrospective cohort study to determine how prevalent anemia and associated morbidity and mortality are at and after hospital discharge.

A total of 445,371 surviving adults who had 801,261 hospitalizations at one of 12 hospitals within an integrated health care delivery system between January 2010 and December 2014 were enrolled in the study. The researchers measured hemoglobin levels and RBC transfusion, rehospitalization and mortality events within 6 months of hospital discharge.

Moderate anemia was defined as hemoglobin levels between 7 g/dL and 10 g/dL.

During the study period, there was an increase in the incidence of moderate hospital discharge from 20% to 25% and a 28% decline in RBC transfusion (39.8 to 28.5 RBC units per 1,000 patients).

There was a decrease in the percentage of patients whose moderate anemia resolved within 6 months of hospital discharge from 42% to 34%. Additionally, RBC transfusion within 6 months of hospital discharge decreased from 19% to 17% and rehospitalization within 6 months of hospital discharge decreased from 37% to 33%.

In patients with moderate anemia there was a decrease in the adjusted 6-month mortality rate from 16.1% in 2010 to 15.6% in 2014.

“These data support the efficacy and safety of practice recommendations to limit RBC transfusion in patients with anemia during and after hospitalization,” Roubinian and colleagues concluded.

In an accompanying editorial, Aryeh Shander, MD, from Englewood Hospital and Medical Center, New Jersey, and Lawrence Tim Goodnough, MD, from Stanford University, cast doubt on the outcome of the study.

“Transfusion rate is not a clinical outcome, and mortality and readmission — although important — might not provide an accurate or comprehensive snapshot of patient well-being,” they wrote. “Missing here is a wide spectrum of morbidity outcomes and issues related to diminished quality of life that do not reach the level of severity that would necessitate admission but nonetheless detract from patients’ health and well-being.” – by Alaina Tedesco

Disclosures: Roubinian reports receiving grants from NIH. Please see study for all other authors’ relevant financial disclosures.