March 1, 2018

'A win-win': Blood transfusion rates are falling after a 20-year climb, study finds

Daily Briefing

    After rising for nearly 20 years, transfusions of red blood cells and plasma have started to decline, according to an analysis published in JAMA—a change that one study author called "a win-win for everybody."

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    Study details

    For the study, researchers examined a national sample that included about 20% of all hospital inpatient discharges from 1993 to 2014.

    They found that transfusion rates reached a peak in 2011, when about 6.8% of inpatients received a red blood cell transfusion, before falling to 5.7% in 2014. Similarly, the percentage of patients who received a plasma transfusion dropped from 1% in 2011 to 0.87% in 2014.

    The drop in red blood cell transfusions was especially steep, at 26%, for patients having elective surgeries. For patients having non-elective surgeries, the drop was 14%.

    The study authors note that they examined only inpatient care, so their findings may not apply in outpatient settings.

    Discussion

    In the study, the researchers wrote that the decrease in transfusions "may reflect evidence demonstrating the safety of restricting [red blood cell] transfusions, patient blood management programs, conservation initiatives (e.g., cell salvage, pharmacotherapy, improved surgical techniques), advocacy from medical organizations, and publication of transfusion guidelines."

    In particular, research has shown that it's safe not to provide red blood cell transfusions to patients whose hemoglobin levels fall between 7 and 10 grams per deciliter, according to HealthDay News. That finding enabled providers to create new, more effective blood management programs.

    Ross Herron, the CMO of the Western division of the American Red Cross, who was not involved in the study, said, "More efficient use of blood is a good thing because we want to make sure that we have a supply when people need it." He emphasized, however, that the Red Cross is still in need of blood donations—especially to maintain the supply of platelets, which have a shelf-life of just five days.

    Aaron Tobian, the senior author of the study and the director of transfusion medicine at Johns Hopkins University's School of Public Health, said the decline in transfusions is a "win-win for everybody."

    Tobian explained, "Fewer transfusions are good for multiple reasons. Our blood supply is safer than ever, but there's always a slight risk to patients" who receive a transfusion. He added, "There's an economic benefit to fewer transfusions, and blood is a scarce resource" (Frellick, Medscape, 2/27; Gordon, HealthDay News/U.S. News & World Report, 2/27).

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