Blood transfusion guidelines may require further evaluation with an eye to reducing transfusions for patients with stable blood pressure, according to Divyajot Sadana, MD, from the Cleveland Clinic, who presented study findings at the CHEST Annual Meeting 2019 in New Orleans.
The Joint Commission on Accreditation of Healthcare Organizations has identified blood transfusions as an overused procedure, and the American Association of Blood Banks advises limiting transfusion to patients who are risk of shock, cardiovascular failure, circulatory collapse and decreased blood flow or have a hemoglobin value of less than 7 g/dL.
The researchers evaluated the necessity and outcome of transfusions by reviewing charts of the 888 patients who accounted for the 1,009 admissions to the medical intensive care unit (MICU) and required at least one blood transfusion from January 2015 to December 2015.
Although the Cleveland Clinic MICU closely adheres to blood conservation, a proportion of patients with stable blood pressures who received blood transfusions might have benefited from closer scrutiny. The researchers found that 13% of transfusions were prescribed in deference to transfusion guidelines and could have been potentially avoided.
“We identified a specific group of patients for whom blood transfusion can be safely avoided,” Sadana says in a statement. “Closer inspection, greater scrutiny and a vigorous investment in a restrictive transfusion practice could have significant implications on both financial and patient outcomes.”
“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,” Michelle Cao, MD, member of the American College of Chest Physicians Scientific Presentations and Awards Committee and clinical associate professor at Stanford University, California, says in a statement.
“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,” says Cao.