Blood transfusions are a common hospital procedure. But according to a study published last month in the Journal of the American Medical Association (JAMA), the more red blood cells hospital patients receive, the higher their risk of infection.
Researchers from the University of Michigan Health System and the VA Ann Arbor Healthcare System concluded that the highest risk was among elderly patients who had hip or knee surgeries. The fewer the number of transfusions, the lower the risk of infection. For every 38 hospitalized patients considered for a red blood cell transfusion (RBC), one would be spared a serious infection if fewer transfusions were used.
According to a story on the U-M website, the result was “most likely due to the patient’s immune system reacting to donor blood [known as transfusion-associated immunomodulation or TRIM]. Transfusions may benefit patients with severe anemia or blood loss; however, for patients with higher red blood cell levels, the risks may outweigh the benefits,” said lead author Jeffrey M. Rohde, M.D., at the U-M Medical School.
Transfusions often are given in the case of anemia or to replace blood loss during surgery.
According to U-M, approximately 14 million red blood cell units were used in the U.S. in 2011, mostly for hospitalized patients. Recent guidelines promote a lower threshold of hemoglobin (blood protein that transports oxygen and gives blood its red color), but only about 1 in 4 hospitals that responded to the National Blood Collection and Utilization Survey reported using them after surgery. Only 3 in 10 hospitals reported having a blood management program to optimize the care of patients who might need a transfusion.
The researchers evaluated all health-care-associated infections that were reported after patients received donor blood in 21 randomized, controlled trials. They included life-threatening infections such as pneumonia and bloodstream and wound infections.
As you might expect, risks of additional hospital infections were especially high for patients who already had sepsis, in which the body’s immune system overreacts to an infection. It’s a dire situation that can lead to organ failure and death. (See our recent blog, “Boy’s Death from Misdiagnosis Points Up CDC’s Inadequate Sepsis Information.”) This study showed that patients with sepsis were twice as likely to develop additional infections when they received more transfusions.
So what can you do to minimize the chances of getting a transfusion unnecessarily? The Choosing Wisely campaign (a national effort that encourages physicians, patients and other health-care stakeholders to ponder and discuss medical tests and procedures that might be unnecessary and/or can cause harm) recommends that patients and their loved ones/advocates who are planning a hospital stay discuss transfusions in advance of their admission.
Ask your doctor and the hospital’s patient advocate these questions:
- What can I do before hospitalization to prevent or decrease my likelihood of developing anemia?
- How can blood loss can be minimized when I am hospitalized? Would any of the options be available for me?
- What are the criteria the hospital uses to decide whether or not I would need a blood transfusion?
- Will you keep me and my family informed during the hospitalization regarding these options, the number and types of transfusions that I was given and tell me what I can do to help?
Keep in mind that your diet, the medications you take and medical conditions you might have (kidney disease, for example) can affect your chances of developing anemia, and whether you will need a transfusion. Discuss these factors with your doctor so you can work together before, during and after your hospitalization.
