Red Blood Cell, Plasma Transfusions Declining in US Hospitals

Marcia Frellick

February 27, 2018

Red blood cell (RBC) and plasma transfusions are decreasing in US hospitals after steadily increasing for more than 2 decades, according to a large, population-based analysis.

"From 2011 to 2014, statistically significant reductions in RBC transfusions were seen among all sexes, race/ethnicities, patient risk severities, payer types, and admission types," Ruchika Goel, MD, MPH, from the Department of Pathology at Weill Cornell Medical College in New York City, and colleagues write.

The reversal in the trend, reported today in JAMA, is important because more hospitals have launched blood management programs to restrict transfusions, which is one of the most common hospital procedures. Such restrictions aim to improve patient outcomes, cut costs, and conserve blood after randomized trials showed the safety of such programs.

The authors used weighted estimates for from 33 million to 38 million discharges each year in the National Inpatient Sample (1993 - 2014) and looked at how many patients had been transfused with a particular blood component. The sample represents about 96% of the US population.

The percentage of hospitalized patients who received RBC transfusions decreased from a peak of 6.8% in 2011 to 5.7% in 2014 (adjusted risk ratio [aRR], 0.83; 95% confidence interval [CI], 0.78 - 0.88). Similarly, the proportion of patients who received a plasma transfusion went from 1.0% in 2011 to 0.87% in 2014 (aRR, 0.87; 95% CI, 0.80 - 0.95).

Among elective admissions, the relative decline in RBC transfusions was significantly larger, at 26% (aRR, 0.74; 95% CI, 0.67 - 0.80), than for nonelective admissions, at 14% (aRR, 0.86; 95% CI, 0.81 - 0.91; P for interaction < .001).

The authors write that the decreases "may reflect evidence demonstrating the safety of restricting RBC transfusions, patient blood management programs, conservation initiatives (eg, cell salvage, pharmacotherapy, improved surgical techniques), advocacy from medical organizations, and publication of transfusion guidelines."

The researchers found no decrease in red blood cell transfusion among pediatric patients, or for platelet transfusions overall. In those areas, there is limited evidence to inform practice.

The newly reported findings build on previous descriptive studies. One previous study with similar findings did not include children and did not evaluate trends in plasma or platelet transfusions.

Goel and colleagues note that in the current study, they only considered inpatient transfusions, which might not be generalizable to outpatient settings.

Coauthors report receiving personal fees from Terumo BCT, Haemonetics, and Octapharma.

JAMA. Published online February 27, 2018. Abstract

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