Changing trends in blood transfusion: an analysis of 244,013 hospitalizations

Shehata, Nadine; Forster, Alan J.; Lawrence, Nadine; Rothwell, Deanna M.; Fergusson, Dean; Tinmouth, Alan; Wilson, Kumanan

doi:10.1111/trf.12644

Cited by 48 publications

(47 citation statements)

References 31 publications

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“…This increased focus was highlighted by the 2011 National Blood Collection and Utilization Survey in which approximately one‐third of hospitals responded that they were utilizing some elements of a blood conservation program . The National Blood Collection and Utilization Survey reported a 7.4% decline in the number of allogeneic RBCs transfused nationally compared to 2008, and similar declines have been observed in Canada and the United Kingdom …”

Section: Discussionmentioning

confidence: 65%

“…Several studies have shown blood conservation programs to be effective in reducing blood utilization and healthcare costs in cardiac and orthopedic surgery . Recent studies have evaluated the impact of these programs on transfusion practice, and we recently reported no correlation between decreased RBC use and mortality across an entire hospital population . In this report, we examined trends in RBC utilization and mortality in patients previously studied in clinical trials as well as other subgroups.…”

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confidence: 99%

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Trends in red blood cell transfusion and 30‐day mortality among hospitalized patients

et al. 2014

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Background Blood conservation strategies have been shown to be effective in decreasing red blood cell (RBC) utilization in specific patient groups. However, few data exist describing the extent of RBC transfusion reduction or their impact on transfusion practice and mortality in a diverse inpatient population. Methods We conducted a retrospective cohort study using comprehensive electronic medical record data from 21 medical facilities in Kaiser Permanente Northern California (KPNC). We examined unadjusted and risk-adjusted RBC transfusion and 30-day mortality coincident with implementation of RBC conservation strategies. Findings The inpatient study cohort included 391,958 patients who experienced 685,753 hospitalizations. From 2009 to 2013, the incidence of RBC transfusion decreased from 14.0% to 10.8% of hospitalizations; this change coincided with a decline in pre-transfusion hemoglobin levels from 8.1 to 7.6 g/dL. Decreased RBC utilization affected broad groups of admission diagnoses and was most pronounced in patients with a nadir hemoglobin level between 8 and 9 g/dL (n=73,057; 50.8% to 19.3%). During the study period, the standard deviation of risk adjusted RBC transfusion incidence across hospitals decreased by 44% (p <0.001). 30-day mortality did not change significantly with declines in RBC utilization in patient groups previously studied in clinical trials nor in other subgroups. Conclusions Following the implementation of blood conservation strategies, RBC transfusion incidence and pre-transfusion hemoglobin levels decreased broadly across medical and surgical patients. Variation in RBC transfusion incidence across hospitals decreased from 2010 to 2013. Consistent with clinical trial data, more restrictive transfusion practice did not appear to impact 30-day mortality.

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Section: Discussionmentioning

confidence: 65%

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confidence: 99%

Trends in red blood cell transfusion and 30‐day mortality among hospitalized patients

et al. 2014

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“…The Ottawa Hospital's Data Warehouse is a large data repository for the hospital's information systems that includes the hospital's administrative, laboratory, and discharge abstract information databases. The Data Warehouse is optimally structured for transfusion research, permitting identification of transfusion recipients, and tracking their use of hospital services and health outcomes …”

Section: Methodsmentioning

confidence: 99%

Risk of exposure to blood products during pregnancy: guidance for Zika and other donor deferral policies

et al. 2017

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Data from a large tertiary care center suggest that the risk of maternal and fetal exposure to blood products by transfusion during any stage of pregnancy is very low. Such a low likelihood of transfusion should be taken into consideration when developing donor deferral policies designed to protect women against transfusion-associated infection transmission during pregnancy and could inform evaluations of the risk of prenatal transfusion transmission of the Zika virus.

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“…The majority of cases in our series involved transfusions in immunocompetent hosts. Although immunocompromised recipients comprised a considerable proportion in our cohort, the latter appeared no more enriched with such patients than other populations requiring transfusions, 34 (Table 6), and the immunecompromised proportion did not change in successive eras, with presumed more prevalent application of irradiation policies and universal leukoreduction. Our findings question whether, or to what degree, underlying immune deficiencies contribute to susceptibility to TA-GVHD and to what degree these are incidental surrogates of exposure opportunities to other drivers of risk.…”

Section: Org Frommentioning

confidence: 96%

A systematic review of transfusion-associated graft-versus-host disease

Kopolovic¹,

Ostro²,

Tsubota

et al. 2015

Blood

160

163

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• Fifty percent of TA-GVHD cases occur in patients who would not be predicted to be at risk for TA-GVHD by current guidelines for blood irradiation.• Donor lymphocytes whose HLA antigens are all shared by the recipient dominate in TA-GVHD cases, particularly in immune-competent recipients.Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication of blood transfusion. The clinicolaboratory features of TA-GVHD and the relative contributions of recipient and component factors remain poorly understood. We conducted a systematic review of TA-GVHD reports. The HLA relationship between donor and recipient was classified as D 5 0 when no donor antigens were foreign to the recipient vs D ‡ 1 when ‡1 donor antigen disparity occurred. We identified 348 unique cases. Criteria for component irradiation were met in 48.9% of cases (34.5% immune-compromised, 14.4% related-donor), although nonirradiated components were transfused in the vast majority of these (97.6%). Components were typically whole blood and red cells. When reported, component storage duration was £10 days in 94%, and 23 (6.6%) were leukoreduced (10 bedside, 2 prestorage, and 11 unknown). Among 84 cases with HLA data available, the category of D 5 0 was present in 60 patients (71%) at either HLA class I or II loci and was more common among recipients without traditional indications for component irradiation. These data challenge the historic emphasis on host immune defects in the pathogenesis of TA-GVHD. The dominant mechanism of TA-GVHD in both immunocompetent and compromised hosts is exposure to viable donor lymphocytes not recognized as foreign by, but able to respond against, the recipient. (Blood. 2015;126(3):406-414)

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Changing trends in blood transfusion: an analysis of 244,013 hospitalizations

Abstract: Although there has been a reduction in the mean RBC units used, there has been an increase in the proportion of hospitalizations transfused. A better understanding of the indications for transfusion is required to facilitate the development of targeted blood conservation strategies.

Cited by 48 publications

References 31 publications

Trends in red blood cell transfusion and 30‐day mortality among hospitalized patients

Trends in red blood cell transfusion and 30‐day mortality among hospitalized patients

Risk of exposure to blood products during pregnancy: guidance for Zika and other donor deferral policies

A systematic review of transfusion-associated graft-versus-host disease

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