Restrictive red blood cell transfusion may decrease risk of infection

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1. Transfusion protocols employing restrictive transfusion thresholds demonstrate a decreased risk of infection as compared to those employing morel liberal thresholds. 

2. Thirty-eight patients need to be treated with a restrictive transfusion protocol in order to prevent one health care-associated infection. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: One method by which red blood cell transfusions are thought to increase the risk of health care-associated infection is via indirect immune alteration. Various transfusion strategies have consequently been trialed in an attempt to limit the effects of this immunomodulation, including variations in the hemoglobin level at which transfusion is considered necessary. This meta-analysis advocates for the potential utility of a more widespread use of restrictive transfusion thresholds. Though limited by the inherent difficulties of comparing and capturing the nuances of multiple randomized controlled trials, this study highlights an important facet of the clinical decision making process. Further studies are required to exam the relationship between transfusion thresholds and infectious outcomes.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Red blood cell transfusion: A clinical practice guideline from the AABB

In-Depth [systematic review and meta-analysis]: This study reviewed 18 randomized controlled trials comparing the incidence of infectious sequelae following restrictive and liberal red blood cell transfusion protocols. Combining data from a total of 7593 patients, the risk of serious infection was noted at 16.9% (95% CI, 8.9-25.4) in those patients treated with liberal transfusion protocols versus 11.8% (95% CI, 7.9-16.7) in those treated with more restrictive parameters. Thirty-eight patients need to be treated with a restrictive protocol in order to prevent one health care-associated infection (95%CI, 24-122) decreasing the number of infections by 26.5 (95% CI, 8.2-42.5) per 1000 patients.

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