A systematic review of the effect of red blood cell transfusion on mortality: evidence from large-scale observational studies published between 2006 and 2010 (original) (raw)
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Transfusion, 2009
BACKGROUND: Red blood cell (RBC) use varies greatly between countries but the underlying reasons are not well understood. Some insight might be gained from blood utilization studies that provide a complete view of the clinical conditions that place individuals at risk of transfusion. This review considers the methodology of published studies that might provide such information and proposes requirements for future studies. STUDY DESIGN AND METHODS: A literature search was performed to identify quantitative studies of RBC use related to clinical data, for which the findings are representative of well-defined populations. Extraction and analysis of methodologic information and epidemiologic data were performed.
Transfusion, 2010
BACKGROUND: Red blood cell (RBC) use varies greatly between countries but the underlying reasons are not well understood. Some insight might be gained from blood utilization studies that provide a complete view of the clinical conditions that place individuals at risk of transfusion. This review considers the methodology of published studies that might provide such information and proposes requirements for future studies. STUDY DESIGN AND METHODS: A literature search was performed to identify quantitative studies of RBC use related to clinical data, for which the findings are representative of well-defined populations. Extraction and analysis of methodologic information and epidemiologic data were performed.
BMJ Open
IntroductionThere has been a significant increase in the number of systematic reviews and meta-analyses of randomised controlled trials investigating thresholds for red blood cell transfusion. To systematically collate, appraise and synthesise the results of these systematic reviews and meta-analyses, we will conduct an overview of systematic reviews.Methods and analysisThis is a protocol for an overview of systematic reviews. We will search five databases: MEDLINE, Embase, Web of Science Core Collection, PubMed (for prepublication, in process and non-Medline records) and Google Scholar. We will consider systematic reviews and meta-analyses of randomised controlled trials evaluating the effect of haemoglobin thresholds for red blood cell transfusion on mortality. Two authors will independently screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full-text review. We will extract data onto a predefined form designed to...
The epidemiology of red cell transfusion
Vox Sanguinis, 2010
Background and Objectives Understanding of the clinical usage of red cells is limited despite its importance in transfusion practice improvement and planning for blood supply requirements. Previous studies have described red cell use based upon ICD and hospital discharge codes; however, such approaches are open to misclassification. This study addresses this limitation by undertaking an epidemiological analysis of red cell use using case note review. Materials and Methods Patient, disease and contextual factors were extracted from the medical records of a randomly selected sample of hospital patients in Northern Ireland who received a red cell transfusion during 2005 (n = 1474). Results Transfused patients received a total of 3804 units (median of two units per transfusion episode). Most transfusions occurred in a medical setting (71%). Patients undergoing treatment for gastrointestinal conditions were responsible for the majority of the demand (29% of transfusion episodes; 34% of red cell units). The presence of bleeding and abnormal tests of coagulation were associated with receiving larger transfusions (‡ 3 units), while patients undergoing orthopaedic surgery and those with a haemoglobin level over 7 g ⁄ dl had the lowest risk of receiving ‡ 3 units in any one transfusion episode. Conclusion The majority of red cells are now prescribed in a medical setting. With an ageing population and increasing therapeutic interventions, the demand for blood is likely to increase despite efforts to reduce usage by eliminating inappropriate transfusions through education and behaviour change. The post-transfusion target (and therefore the number of units to transfuse) for any given clinical situation as well as guidance on a 'safe' transfusion threshold should be considered in future guidelines.
BMJ (Clinical research ed.), 2015
To compare the benefit and harm of restrictive versus liberal transfusion strategies to guide red blood cell transfusions. Systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. Cochrane central register of controlled trials, SilverPlatter Medline (1950 to date), SilverPlatter Embase (1980 to date), and Science Citation Index Expanded (1900 to present). Reference lists of identified trials and other systematic reviews were assessed, and authors and experts in transfusion were contacted to identify additional trials. Published and unpublished randomised clinical trials that evaluated a restrictive compared with a liberal transfusion strategy in adults or children, irrespective of language, blinding procedure, publication status, or sample size. Two authors independently screened titles and abstracts of trials identified, and relevant trials were evaluated in full text for eligibility. Two reviewers then independently extracted data on method...
BMC Medicine
Background There are no overviews of systematic reviews investigating haemoglobin thresholds for transfusion. This is important as the literature on transfusion thresholds has grown considerably in recent years. Our aim was to synthesise evidence from systematic reviews and meta-analyses of the effects of restrictive and liberal transfusion strategies on mortality. Methods This was a systematic review of systematic reviews (overview). We searched MEDLINE, Embase, Web of Science Core Collection, PubMed, Google Scholar, and the Joanna Briggs Institute EBP Database, from 2008 to 2018. We included systematic reviews and meta-analyses of randomised controlled trials comparing mortality in patients assigned to red cell transfusion strategies based on haemoglobin thresholds. Two independent reviewers extracted data and assessed methodological quality. We assessed the methodological quality of included reviews using AMSTAR 2 and the quality of evidence pooled using an algorithm to assign GR...
Transfusion, 1994
Background: The urpose of this study was to evaluate the criteria for assessing the appropriateness orred cell transfusions. The data were obtained by a computer search of all English-language literature from 1966 to October 1992. Study Design and Methods: Nine studies were selected, which dated from 1986 to 1989 and employed explicit criteria evaluating the appro riateness of red cell transfusion in adults. The following data were abstracted [om all studies: study design, timing, location, criteriafor evaluating appropriateness, and rate of appropriate or inappro riate transfusions. Results: #ve studies evaluated transfusion appropriateness. Appropriateness rates ranged from 88 to 99 percent in three studies, and inappropriateness rates ranged from 0.3 to 57.3 percent in two studies. Four studies evaluated transfusion inappropriateness and reported inappropriateness rates of 18 to 55 percent. Substantial variation was found in the criteria for an appropriate or an inappropriate transfusion. Appropriateness rates did not depend upon characteristics of the stud design, location, or timing of data collection. Restrictiveness in the criteria used to Jetermine appropriateness and the use of additional implicit evaluation after an initial explicit review affected appro riateness rates. Conclusion: In the 1!$8Os, high rates of inappropriate transfusion and low rates of appropriate transfusion were still reported. Ap ropriateness rates varied widely, in derived standards for an appropriate red cell transfusion, published in 1992, appear to provide a simple and objective means of evaluating the appropriateness of a transfusion. Appropriateness rates resultin from the a plication of these new standards have not yet been determined. T#ANSFUSIOd)1994;34:110-115.
Trends in red blood cell transfusion and 30-day mortality among hospitalized patients
Transfusion, 2014
Blood conservation strategies have been shown to be effective in decreasing red blood cell (RBC) utilization in specific patient groups. However, few data exist describing the extent of RBC transfusion reduction or their impact on transfusion practice and mortality in a diverse inpatient population. We conducted a retrospective cohort study using comprehensive electronic medical record data from 21 medical facilities in Kaiser Permanente Northern California. We examined unadjusted and risk-adjusted RBC transfusion and 30-day mortality coincident with implementation of RBC conservation strategies. The inpatient study cohort included 391,958 patients who experienced 685,753 hospitalizations. From 2009 to 2013, the incidence of RBC transfusion decreased from 14.0% to 10.8% of hospitalizations; this change coincided with a decline in pretransfusion hemoglobin (Hb) levels from 8.1 to 7.6 g/dL. Decreased RBC utilization affected broad groups of admission diagnoses and was most pronounced ...
Transfusion Medicine Reviews, 2011
An international multidisciplinary panel of 15 experts reviewed 494 published articles and used the RAND/ UCLA Appropriateness Method to determine the appropriateness of allogeneic red blood cell (RBC) transfusion based on its expected impact on outcomes of stable nonbleeding patients in 450 typical inpatient medical, surgical, or trauma scenarios. Panelists rated allogeneic RBC transfusion as appropriate in 53 of the scenarios (11.8%), inappropriate in 267 (59.3%), and uncertain in 130 (28.9%). Red blood cell transfusion was most often rated appropriate (81%) in scenarios featuring patients with hemoglobin (Hb) level 7.9 g/dL or less, associated comorbidities, and age older than 65 years. Red blood cell transfusion was rated inappropriate in all scenarios featuring patients with Hb level 10 g/dL or more and in 71.3% of scenarios featuring patients with Hb level 8 to 9.9 g/dL. Conversely, no scenario with patient's Hb level of 8 g/dL or more was rated as appropriate. Nearly one third of all scenarios were rated uncertain, indicating the need for more research. The observation that allogeneic RBC transfusions were rated as either inappropriate or uncertain in most scenarios in this study supports a more judicious transfusion strategy. In addition, the large number of scenarios in which RBC transfusions were rated as uncertain can serve as a road map to identify areas in need of further investigation.
Are Blood Transfusions Associated with Greater Mortality Rates?
Anesthesiology, 2008
Background Studies have suggested worse outcomes in transfused patients and improved outcomes in patients managed with restricted blood transfusion strategies. The authors investigated the relation of blood transfusion to mortality in European intensive care units (ICUs). Methods The Sepsis Occurrence in Acutely Ill Patients study was a multicenter, observational study that included all adult patients admitted to 198 European ICUs between May 1 and May 15, 2002 and followed them until death, until hospital discharge, or for 60 days. Patients were classified depending on whether they had received a blood transfusion at any time during their ICU stay. Results Of 3,147 patients, 1,040 (33.0%) received a blood transfusion. These patients were older (mean age, 62 vs. 60 yr; P = 0.035) and were more likely to have liver cirrhosis or hematologic cancer, to be a surgical admission, and to have sepsis. They had a longer duration of ICU stay (5.9 vs. 2.5 days; P < 0.001) and a higher ICU m...