Infection Risk Raised After Blood Transfusions

Mary A.M. Rogers, PhD, MS Research Associate Professor Research Director, Patient Safety Enhancement Program Department of Internal Medicine University of Michigan Ann Arbor, MI  48109-2800MedicalResearch.com Interview with:
Mary A.M. Rogers, PhD, MS
Research Associate Professor
Research Director, Patient Safety Enhancement Program
Department of Internal Medicine
University of Michigan Ann Arbor, MI  48109-2800

MedicalResearch.com: What are the main findings of the study?

Dr. Rogers: The risk of serious infection is considerably elevated after receiving allogeneic (donor) red blood cell transfusions.  For every 38 patients under consideration for transfusion, 1 patient could be spared an infection if more restrictive hemoglobin thresholds were used.  When patients were given transfusions only after their hemoglobin fell below 7.0 g/dL, 1 patient avoided an infection of every 20 patients treated.  The results were most consistent in elderly patients receiving hip and knee replacement surgeries.  Their risk of infection decreased by 30% when lower hemoglobin thresholds were used.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Rogers: The association between transfusion and infection has been previously reported but because the findings come from 18 randomized controlled trials, it demonstrates definitive evidence of this risk.  Since the trials, in general, underreported infections, the number of infections prevented by using a more restrictive hemoglobin threshold may be even greater than reported here.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Rogers: A nationwide effort called the “Choosing Wisely” campaign by the American Board of Internal Medicine (www.choosingwisely.org) recommends that patients planning for surgery or a hospital admission discuss transfusions and other common medical procedures with their physician ahead of time.  Excessive red blood cell transfusions when anemia is not present do not improve patient outcomes.  Patients should discuss ways to prevent anemia with their physician and how their diet, medications, and medical conditions may impact their hemoglobin levels.  Patients should also talk with their doctor regarding the criteria used at their hospital to decide whether or not a transfusion would be ordered.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Rogers: Because blood from donors (i.e., allogeneic blood) causes an immune response in the recipient, I applaud the research efforts to create a limitless and infection-free supply of red blood cells for use when transfusions are necessary.  Such stem cell research should be encouraged.

Citation:
Health Care–Associated Infection After Red Blood Cell Transfusion: A Systematic Review and Meta-analysis