Overuse of blood transfusions increases infection risk

Elderly patients with hip or knee surgery at greatest risk of infection; hospitals urged to use transfusions more sparingly

2014-04-01

(Press-News.org) ANN ARBOR, Mich. — Blood transfusions are one of the most common procedures patients receive in the hospital but the more red blood cells they receive, the greater their risk of infection, says a new study led by the University of Michigan Heath System and VA Ann Arbor Healthcare System.

Researchers analyzed 21 randomized controlled trials for the study that appears in today's Journal of the American Medical Association (JAMA).

Elderly patients undergoing hip or knee surgeries were most susceptible, with a 30 percent lower risk of infection when fewer transfusions were used. Overall, for every 38 hospitalized patients considered for a red blood cell transfusion (RBC), one patient would be spared a serious infection if fewer transfusions were used.

Transfusions are often used for anemia or during surgery to make up for blood loss. The authors evaluated all health care-associated infections that were reported after receiving donor blood in the randomized trials. These included serious infections such as pneumonia, bloodstream infections and wound infections.

"The fewer the red blood cell transfusions, the less likely hospitalized patients were to develop infections, " says lead author Jeffrey M. Rohde, M.D., assistant professor of internal medicine in the division of general medicine at the U-M Medical School.

"This is most likely due to the patient's immune system reacting to donor blood (known as transfusion-associated immunomodulation or TRIM). Transfusions may benefit patients with severe anemia or blood loss; however, for patients with higher red blood cell levels, the risks may outweigh the benefits."

Risks of additional hospital infections were particularly high for patients who already had sepsis – a condition in which the body's immune system overreacts to an infection and may lead to organ failure. Patients with sepsis were twice as likely to develop additional infections when they received more transfusions.

Approximately 14 million red blood cell units were used in the United States in 2011, most often in the hospital. Lower hemoglobin thresholds are recommended by recent guidelines, but only 27 percent of hospitals that responded to the National Blood Collection and Utilization Survey reported using them after surgery. Only 31 percent of hospitals reported having a blood management program that aims to optimize the care of patients who might need a transfusion.

A nationwide effort called the "Choosing Wisely" campaign recommends that patients planning for surgery or a hospital admission discuss transfusions and other common medical procedures with their physician ahead of time. Senior author Mary A. M. Rogers, Ph.D., research associate professor in internal medicine and member of U-M's Institute for Healthcare Policy and Innovation suggests patients ask the following questions:

As a patient, what can I do before hospitalization to prevent or decrease my likelihood of developing anemia?

What are ways that blood loss can be minimized when I am hospitalized? Would any of these options be available for me?

What are the criteria that the hospital uses to decide whether or not I would need a blood transfusion?

Would you please keep me and my family informed during the hospitalization regarding these options, the number and types of transfusions that I was given, and let me know whether there is anything I can do to help?

INFORMATION:

Additional Authors: Derek E. Dimcheff, M.D., Ph.D.; Sanjay Saint, M.D., M.P.H.; Kenneth M. Langa, M.D., Ph.D.; Latoya Kuhn, M.P.H.; and Andrew Hickner, all of U-M. Neil Blumberg, M.D., of the University of Rochester Medical Center in New York.

Funding: National Heart, Lung, and Blood Institute (5R21HL093129-02)

Disclosures: None

Reference: "Healthcare-associated infection after red blood cell transfusion: A systematic review and meta-analysis," JAMA

ELSE PRESS RELEASES FROM THIS DATE:

Medication does not help prevent ED following radiation therapy for prostate cancer

2014-04-01

Among men undergoing radiation therapy for prostate cancer, daily use of the erectile dysfunction drug tadalafil, compared with placebo, did not prevent loss of erectile function, according to a study in the April 2 issue of JAMA. Erectile dysfunction (ED) is a common condition resulting from many causes, including prostate cancer treatment. An estimated 40 percent of men report ED after radiation therapy, and half of all men use erectile aids following this therapy. Tadalafil is used to treat erectile dysfunction after prostate cancer treatment, but its role as a preventive ...

Outcomes of administering blood transfusions to patients with lower levels of hemoglobin

2014-04-01

Restricting red blood cell (RBC) transfusions among hospitalized patients to those with hemoglobin (the iron-containing protein in RBCs) measures below a certain level is associated with a lower risk of health care-associated infections, according to a study in the April 2 issue of JAMA. Efforts to prevent health care-associated infection are among the priorities for the U.S. Department of Health and Human Services. The estimated annual direct medical costs of health care-associated infections to U.S. hospitals ranges from $28 billion to $45 billion, with about 1 in ...

The potential conflict of interest for leaders of AMCs serving on pharmaceutical boards

2014-04-01

About 40 percent of pharmaceutical company boards of directors examined had at least one member who held a leadership position at an academic medical center, with annual compensation for these positions averaging approximately $300,000, according to a study in the April 2 issue of JAMA. "Financial relationships between the pharmaceutical industry and physicians have come under increased scrutiny. Less attention has been paid to relationships between industry and the leadership of academic medical centers (AMCs), who wield considerable influence over research, clinical, ...

Experts question routine mammograms in elderly

2014-04-01

Doctors should focus on life expectancy when deciding whether to order mammograms for their oldest female patients, since the harms of screening likely outweigh the benefits unless women are expected to live at least another decade, according to a review of the scientific literature by experts at UCSF and Harvard medical schools. National guidelines recommend that doctors make individualized screening decisions for women 75 and older. But the analysis, published online Tuesday in JAMA (March 31, 2014), concluded that since this age group was not included in mammography ...

Night owls, unlike early birds, tend to be unmarried risk-takers

2014-04-01

Women who are night owls share the same high propensity for risk-taking as men, according to a recent study by a University of Chicago professor. The research suggests that sleep patterns are linked with important character traits and behavior, said study author Dario Maestripieri, professor in Comparative Human Development. Night owls—people who tend to stay up late and wake up late in the morning—are different in many important ways from early risers, he found. "Night owls, both males and females, are more likely to be single or in short-term romantic relationships ...

Like hand-washing, blood transfusions linked to infections

2014-04-01

Blood transfusions are among the most common treatments for hospitalized patients nationwide, but doing them less often reduces infection rates by nearly 20 percent, according to a study in the Journal of the American Medical Association co-authored by Neil Blumberg, M.D., professor at the University of Rochester School of Medicine and Dentistry. As director of transfusion medicine and the blood bank at UR Medicine, Blumberg for more than 25 years has been investigating how to make blood transfusions safer. The JAMA study is the first to show conclusively, through a study ...

A protein could be a key weapon in the battle of the bulge

2014-04-01

Bethesda, MD (April 1, 2014)— More than one-third of people in the US are obese. Obesity and its related health problems—including high blood pressure, high cholesterol, diabetes, insulin resistance, and belly fat—affect so many, yet effective treatments are very few. In a new study, Simon Musyoka Mwangi and colleagues tested whether higher levels of a certain protein help fight the weight gain and health problems caused by eating the wrong foods. Glial cell line-derived neurotrophic factor—or GDNF for short—is a protein integral to keeping the body's systems in balance ...

Adult tonsillectomy complications and health care expenses

2014-04-01

A study released today of 36,210 adult tonsillectomy patients finds that 20 percent will have a complication, offering valuable new insights to a decades long discussion. The study, featured in the April 2014 issue of Otolaryngology—Head and Neck Surgery, examines the prevalence of complications in adult tonsillectomies and the impact on health care expenditures. "Researchers have been examining variation in tonsillectomy for years," explained corresponding author, Dennis Scanlon, PhD. "Yet most research has been documented in pediatric populations. Much less is known ...

Deforestation of sandy soils a greater climate threat

2014-04-01

Deforestation may have far greater consequences for climate change in some soils than in others, according to new research led by Yale University scientists — a finding that could provide critical insights into which ecosystems must be managed with extra care because they are vulnerable to biodiversity loss and which ecosystems are more resilient to widespread tree removal. In a comprehensive analysis of soil collected from 11 distinct U.S. regions, from Hawaii to northern Alaska, researchers found that the extent to which deforestation disturbs underground microbial ...

Researchers identify similarities between HIV/AIDS and opioid addiction epidemics

2014-04-01

(PROVIDENCE, R.I.) – There are important parallels between the early years of the HIV/AIDS epidemic and the current epidemic of opioid addiction - ones that could trigger a significant shift in opioid addiction prevention, diagnosis and treatment. These are the findings of a comparative review of HIV/AIDS and addiction by researchers Josiah D. Rich, M.D., M.P.H., director of the Center for Prisoner Health and Human Rights, based at The Miriam Hospital; Traci C. Green, Ph.D., MSc, Department of Emergency Medicine at Rhode Island Hospital and assistant professor of Emergency ...

Overuse of blood transfusions increases infection risk

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: