CHEST 2019 — Blood transfusions overused in patients with stable blood pressure


  • Keren Landman, MD
  • Actualités des congrès
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Takeaway

  • Over 1 in 10 blood transfusions in a MICU setting could have been safely avoided, but were nevertheless prescribed out of deference to clinical practice guidelines.

Why this matters

  • Blood transfusions have been named one of the most overused procedures by JCAHO, and the American Association of Blood Banks advises limiting transfusions to patients at risk of shock, cardiovascular failure, circulatory collapse, and decreased blood flow, or with a Hb

Study design

  • Retrospective chart review of 888 MICU-admitted patients requiring blood transfusions between January and December, 2015.
  • Funding: none.

Key findings

  • Mean pre-transfusion hemoglobin was 6.75g/dL.
  • 944 of 3140 (30.1%) units of blood were transfused in patients with pre-transfusion Hb ≥7g/dL.
    • Of these, 385 (12.2% of all units) were transfused in patients without hypotension, tachycardia, use of vasopressors, or underlying coronary artery disease.
  • Hospital mortality in transfused patients was 23.3% and was higher in patients transfused with ≥1 unit with a pre-transfusion Hb ≥7g/dL (20.8% vs. 26.2%).
    • APACHE III scores were comparable between the groups.

Limitations

  • Retrospective chart review.

Expert commentary

  • Michelle Cao, MD, member of the American College of Chest Physicians Scientific Presentations and Awards Committee and Clinical Associate Professor at Stanford University, California, was quoted in a press release as commenting: “Clinical practice guidelines are developed after an extensive review of the evidence in order to optimize clinical care and to standardize medical care. This study, although a retrospective outlook, shines light into the transfusion practices of intensive care providers in a typical tertiary hospital. Beyond the investigators’ findings, it is worth taking a deeper dive into the rationale or conditions that contributed to medical professionals not adhering to recommended practice guidelines. Their decision-making has prognostic implications on morbidity, mortality and economic burden.” Dr. Cao was not involved with the study.