RBC transfusion increased risk for death

Discussion in 'Health and medical' started by Doe, Mar 1, 2004.

  1. Doe

    Doe Guest

    CONFIRMING .. previous Canadian study.

    http://www.medscape.com/viewarticle/467534

    <<snip>> RBC transfusion remained statistically significantly associated with an increased risk for
    death <<snip>>

    Blood study could change medical thinking, researcher says

    Associated Press

    By JANET McCONNAUGHEY

    February 22, 1999

    The finding that it is safe - and sometimes better - to cut back on blood transfusions for
    critically ill patients may have effects far beyond the obvious ones of saving blood and money.

    It could open the way for more studies of whether common sense makes medical sense, said Gordon R.
    Barnard, chief of critical care service at Vanderbilt Medical Center in Nashville, Tenn.

    Common sense would say that a normal red cell count is better than a low one, but the work directed
    by doctor Paul C. Hebert shows that isn't always so, Barnard said.

    Hebert, of the University of Ottawa, found that critical care patients are as likely to recover if
    they get transfusions only when they become severely anemic as they are when mild anemia is the
    trigger for transfusion.

    And, it found, the more restrictive strategy is better for patients under the age of 55 and those
    who are less critically ill. Among those patients, those who got more transfusions were more
    likely to die.

    "If common sense is not reliable, we need clinical trials," Barnard said. "I think this paves the
    way for clinical trials that seem to fly in the face of logic."

    He said Hebert's study asked a very simple question in everyday practice: What hemoglobin level is
    best in the ICU?

    "There are a number of questions like that which remain unanswered or inadequately answered, not
    only in general medicine but in critical care, particularly," he said.

    Some of those questions: What is the best oxygen level to maintain? When drugs have to be used to
    raise a patient's blood pressure, what is the best blood pressure to maintain?

    "We don't know if we should try to achieve normal levels, 10 percent less than normal, or
    where. It's probably different depending on what physiological breakdown we're talking about,"
    Barnard said.

    Red-cell transfusions are routine to fight anemia. However, critical care doctors disagree on when
    they are needed. Some give them when a patient becomes slightly anemic, with 10 grams of hemoglobin
    per deciliter of blood, compared to the usual 11.5 to 12.5 grams. Others wait until a patient is
    severely anemic, at 7 grams of hemoglobin per deciliter.

    Hebert and the Canadian Critical Care Trials Group randomly divided 838 critically ill and anemic
    patients into two groups, one for each treatment strategy.

    He said he expected the two approaches to produce similar results, a finding that by itself could
    save millions of dollars a year. And, overall, that was the result, he reported in today's edition
    of the New England Journal of Medicine.

    The 420 patients in the liberal strategy group got an average of 5.6 units of blood apiece, while
    the 418 in the restrictive group averaged
    2.6 units - about 54 percent less.

    In addition, one-third of the patients in the restrictive group did not get any transfusions at all.

    And in two groups, less was better: Younger and less critically sick patients were more likely to
    die if they got more transfusions.

    "This is a landmark study. This is bigtime," said Stephen Cohn, chief of trauma and surgical
    critical care at Jackson Memorial Hospital-University of Miami School of Medicine.

    He and Robert Taylor, president of the Society for Critical Care Medicine, said they plan to use the
    more restrictive guidelines in their ICUs.

    Taylor, of St. John's Mercy Medical Center in St. Louis, emphasized that the findings don't apply to
    several groups of patients. He said that includes patients who are bleeding, whether from ulcers or
    wounds; those suffering from heart attacks or reduced flow of blood to the heart; and those with
    emphysema and cardiovascular disease.

    And, he said, "This is a large study. A well-done study. But there needs to be other studies that
    confirm this."

    Nobody knows just how many patients the nation's ICUs treat a year, or how many
    transfusions they get.

    But the 68-bed ICU at St. John's Mercy used 337 units in November. "If we could cut that by 54
    percent, that's a significant issue," Taylor said.

    __________________________________________________________________________

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