Restrictive criteria for the use of routine blood transfusions in hospitals may help decrease infection rates in patients, according to a meta-analysis in The Journal of the American Medical Association.

The study was led by Mary Rogers, Ph.D., from the University of Michigan and co-authored by Director of the Transfusion Medicine Unit at UR Medical Center Neil Blumberg, M.D.
The article, published this April, offers suggestive evidence that transfusions can be harmful.

Titled “Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis,” the article reviewed 18 clinical trials that together involved approximately 7,593 patients.

Researchers found a 16.8% risk of serious infection associated with a liberal blood transfusion strategy. That contrasted with an 11.8% risk of serious infection associated with a restrictive transfusion strategy. Serious infections range anywhere from wound infection or pneumonia to the potentially fatal sepsis.

According to Blumberg infections are the most common complication of blood transfusions.  “It appears that when you get a blood transfusion from somebody else […] it causes a form of immunomodulation,” Blumberg said. This immunomodulation leaves patients susceptible to serious infection.

Nearly five million Americans are in need of blood transfusions each year, according to the National Heart, Lung and Blood Institute. A blood transfusion is a medical procedure during which a patient is injected with blood through an IV in order to maintain the proper ratio of red blood cells in the body.

Blood transfusions can be life-saving in certain conditions, such as acute anemia or extreme blood loss. Blumberg, who has dedicated the past thirty years to studying hematology with a focus on blood transfusions, said he believes that the prevalent use of transfusions is unjustified.

Discussing the scientific evidence backing the use of transfusions, Blumberg noted the lack of “strong evidence that what [medical professionals are] doing is causing benefit rather than harm.”

Transfusions are given to an estimated three to four million patients per year, according to an article authored by Blumberg and a colleague in 2013. The prevalence of the procedure seems to be an instance of what Blumberg terms “indication creep.”

With respect to the field of medicine, this signifies the assumption that if a procedure worked well in certain circumstances, it could be applied to other medical situations without risk.

Blumberg added that because transfusions can save lives and anemic patients have generally worse health outcomes, it was not an unreasonable conclusion for doctors to arrive at.

What Blumberg’s analysis means for the medical community is a closer look at a routine procedure that may not actually be helping physicians “do no harm,” as directed by the Hippocratic Oath.

“This is the first really definite proof that most people are going to accept that this is true about transfusions,” Blumberg said.

Blumberg added that “we’ve got to start getting people to think of the transfusion as the last resort, not as the first…”

Mitchell is a member of the class of 2014.

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