Outcomes of Protocol-Driven Care of Critically Ill Severely Anemic Patients for Whom Blood Transfusion Is Not an Option*

Abstract

Overall risk of mortality in severely anemic critically ill bloodless patients appeared to be comparable with transfused patients, albeit the latter group had older age and higher Acute Physiology and Chronic Health Evaluation II score. Use of a protocol to manage anemia in these patients in a center with established patient blood management and bloodless medicine and surgery programs is feasible and likely to contribute to improved outcome, whereas more studies are needed to better delineate the impact of such programs.

Mortality and morbidity in non‐transfusable and transfusable patients: A systematic review and meta‐analysis

“…Of the 41 included studies, all were retrospective cohort studies by design, and seven were abstracts 16,22,23,34,39,45,46 . In the majority of studies, the non‐transfusable cohort referred to those declining transfusions for personal or religious reasons 14,16–54 . We identified one study where patients did not receive an option for transfusion, potentially due to limited resources 15 .…”

“…We collected information on the individual PBM strategies applied to manage anemia, bleeding, and coagulopathy (Table S5 to S7, Data S1). Of the 41 studies included, 26 described the application of strategies to manage anemia, 14,18,19,21,24–28,30,32–39,43–45,47,49,50,53,54 with a median of two strategies applied per study; 23 studies described the application of strategies to minimize bleeding, 14,17–20,24–30,33,37,38,40,43,44,47–49,52,54 with a median of two strategies per study; 15 studies described applying strategies for coagulopathy, 14,18,22,26,30,33,36–38,43,44,48,49,52,54 with a median of one strategy per study (Table S18, Data S1).…”

“…Data on short‐term mortality were provided in 35 of the 41 studies included in our review., 14,15,17–34,37–42,44,46–53 with 32 reporting in‐hospital mortality, and three 30‐day mortality. Of these, 12 reported zero deaths in both groups, 17,19,20,25–28,30,33,40,49,53 and the remaining 23 reported no significant differences between groups 14,15,18,21–24,29,31,32,34,37–39,41,42,44,46–48,50–52 . Eleven moderate risk of bias studies were included in the meta‐analysis of short‐term mortality (Figure 2).…”

“…Table 2 presents random‐effects meta‐analyses of secondary outcomes in non‐transfusable patients when compared to transfusable patients. Eighteen studies presented data on infections 14,15,19,21–28,37,38,41,42,45,47,54 . Of these, two studies reported significantly fewer infections in non‐transfusable patients, 15,42 with the remaining 16 reporting no statistically significant differences between groups 14,19,21–28,37,38,41,45,47,54 .…”

“…Data on acute myocardial infarction were available from 16 studies 14,17,18,23,24,26,29,37,38,42,44,47,49,50,52,54 . Two studies reported significantly lower acute myocardial infarction events in non‐transfusable patients 42,47 . The remaining 14 reported no statistically significant differences between groups 14,17,18,23,24,26,29,37,38,44,49,50,52,54 .…”