Blood Transfusion Risks Debated

Over half of all open-heart-surgery patients undergo blood transfusions, supposedly to reduce complication risks, says The Wall Street Journal; however, two emerging studies indicate that many <"">transfusions might be unnecessary.

Unneeded transfusions increase costs, reduce blood supplies, and can increase infection and other adverse health risks, according to cardiologists, said the Journal. Although reports indicate that several hundred thousand Americans undergo this surgery annually, there is a dearth of research on the benefits of related transfusions, noted the Journal.

“The common practice is if your blood count is a little low, we’ll just give you a unit of blood,” said Mark Slaughter, chief of thoracic and cardiovascular surgery at the University of Louisville, quoted the Journal, which noted that Dr. Slaughter was not involved in the studies. “But transfusion is not benign. There really needs to be a clinical indication or a trigger for the transfusions other than just that the blood count is a little bit low,” he added

One study, conducted in Brazil, is, said the Journal, “the first large randomized research effort” conducted with heart-surgery patients and that tested two different types of blood transfusion “strategies.” The study revealed that there was no significant difference in mortality or other serious events between actively conducting transfusions and being more conservative in transfusion approaches, explained the Journal. Of note, of patients receiving transfusions in either strategy, there was a 20-percent increased death risk or risk of other surgical complications versus those who did not receive transfusions.

The second study, led by Elliott Bennett-Guerrero, a researcher at Duke University’s Duke Clinical Research Institute, revealed a broad array of transfusion practices in 798 U.S. hospitals, wrote the Journal. The study looked at 100,000 patients who underwent coronary-artery bypass surgery in 2008 and, while some hospitals performed transfusions in less than 10 percent of their patients, others exceeded 90 percent, wrote the Journal. The research also revealed that only 20 percent of the shift was concerned with patient illness and there was no mortality-transfusion link, said the Journal. Both studies appeared in last week’s Journal of the American Medical Association.

Transfusions are generally performed to correct significant anemia by increasing hemoglobin (red-blood-cell count). “We just don’t have the answer to when is the right time to transfuse the patient or how low can you go with that hemoglobin,” said Colleen Koch, cardiac surgery anesthesiologist at the Cleveland Clinic.

A study published in Critical Care Medicine in 2006, which looked at over 10,000 coronary-artery-bypass operations at the Cleveland Clinic, found much higher mortality, heart attack, surgical-incision infections, and complication risks in transfused patients, added the Journal. It is believed that patient vulnerability is involved.

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