Fewer Blood Transfusions Needed After Surgery

Blood transfusions may not be needed until patients show anemia or low hemoglobin

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Blood transfusions during surgery are common, especially for elderly patients. Doctors say the problem is they may be too common.

An alternate plan for offering transfusions may dramatically cut their use while still protecting patient health.

Patients may not actually need as much blood following surgery. Waiting to transfuse blood until they show signs of anemia or exhibit low hemoglobin uses substantially less blood with no negative health impact on patients.

"Donate blood on a regular basis."

Dr. William Macaulay, a co-author and director of the Center for Hip and Knee Replacement at New York Presbyterian Hospital and Columbia University Medical Center, said the research could help end the debate over the amount of blood needed by patients after surgery.

He noted that more often than not, blood transfusions are not necessary, even for elderly or sick patients.

Dr. Macaulay said that reducing the number of blood transfusions would significantly decrease the use of blood and result in substantial savings. In the U.S., 14.6 million units of blood are transfused each year. Up to 70 percent of those transfusions are given after surgery, and most of those patients are elderly.

An average hemoglobin level is 12 g/dL, and patients commonly receive transfusions when that drops below 10 g/dL, though a growing number of doctors are using anemia symptoms or a lower hemoglobin threshold of 8 g/dL

During the FOCUS (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair) study, researchers followed 2,016 patients over the age of 50 with a history or risk factors for cardiovascular disease who underwent hip fracture surgery. The median age of patients was 82.

Patients were randomly placed into either a liberal group that received blood transfusions when their hemoglobin dropped below 10 g/dL, or a restrictive group in which patients received a transfusion only if they showed symptoms of anemia, or at a doctor's discretion if their hemoglobin was below 8 g/dL.

Both groups had similar outcomes in the risk of dying within 60 days, functional recovery, heart attack risk, infection, falls, and symptoms such as fatigue.

Though the outcomes were similar, the amount of blood used among the groups was substantially different.

Patients in the restrictive group received 65 percent fewer units of blood than the other group, and 58.5 percent of patients in the restrictive group did not receive blood transfusions. The trial reaffirmed a 1999 study showing that intensive care patients who received transfusions at a lower hemoglobin threshold were given less blood and had similar clinical outcomes.

The study was recently published in the New England Journal of Medicine.

Reviewed by: 
Review Date: 
December 18, 2011
Last Updated:
December 19, 2011