Blood Transfusion Therapy

Abstract

Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Randomized, controlled trials of restrictive RBC transfusion practices have shown equivalent patient outcomes compared with liberal transfusion practices, and meta-analyses have shown improved in-hospital mortality, reduced cardiac events, and reduced bacterial infections. This body of level 1 evidence has led to substantial, improved blood utilization and reduction of inappropriate blood transfusions with implementation of clinical decision support via electronic medical records, along with accompanying educational initiatives.

Keywords: Anemia; Clinical decision support; Red blood cell transfusion; Restrictive transfusion practices.

Fig. 1

Risks of major transfusion-transmissible viruses linked to interventions, and accelerating rate of EIDs of concern to blood safety. Evolution of the risks of transmission by blood transfusion for HIV, HBV, and HCV. Major interventions to reduce risks are indicated below the time line on the x-axis. Emerging infectious disease threats over the past 20 years are indicated above in the top right quadrant of the figure. Ab, antibody; Ag, antigen; CHIKV, Chikungunya virus; DENV, dengue virus; HBsAg, hepatitis B surface antigen; ICL, idiopathic CD4⁺ T lymphocytopenia; PTLV, posttransplant lymphoproliferative disease; SARS, severe acute respiratory syndrome; SFV, simian foamy virus; vCJD, variant Creutzfeldt-Jakob disease; WNV, West Nile virus; XMRV, xenotropic murine leukemia virus-related virus.

Fig. 2

Blood components issued to patients at SHC. Transfusion of RBCs per 100 days at risk, decreased by 42% from 2009 through 2015.