Restrictive Blood Transfusion Policy Reached its Bottom

Blood transfusions are becoming increasingly careful in hospitals and standards. Because of the risks connected with blood transfusion, as well as the rising scarcity and cost of blood supplies. For example, the number of patients requiring a transfusion during their ICU stay has been cut in half in recent years.

Researchers from Amsterdam University Medical Center, in partnership with eight other Dutch hospitals, have demonstrated that being more restricted in preventive blood transfusion is not always reasonable. The findings of this study were published in the New England Journal of Medicine.

The study, sponsored by Amsterdam UMC, is a collaboration between critical care doctors and hematologists, both of whom are frequently confronted with blood transfusion complications. The research focused on one of these issues.

“In the ICU, more than half of patients receive a central venous catheter (CVC) for the administration of medication or for dialysis. But what do you do when patients need a CVC and they have a shortage of platelets, which causes clotting problems and increases the tendency to bleed,” says lead researcher and head of Amsterdam UMC’s Intensive Care Unit Alexander Vlaar.

Unexpected Result

A prophylactic platelet transfusion used to be the answer to potential bleeding. However, in recent years, the topic of whether a platelet transfusion is required to successfully place a catheter has become increasingly prevalent in health care. According to transfusion standards, the limit has also been cut in half in the last ten years.

“We therefore entered this study with the expectation that, just as in other situations for which this was already known, we could safely omit a platelet transfusion altogether. But the outcome was different. Patients with very few platelets actually have less bleeding if they are transfused prior to CVC placement,” adds Vlaar.

Maintaining vigilance

The researchers believe that the findings of this study do not imply that all patients should have transfusions as a precautionary measure going forward, but it does demonstrate that any potential cost savings should always be thoroughly evaluated.

“If we had not further investigated this internationally implemented policy, doctors would simply follow this policy from the transfusion guidelines. But we must remain critical on this point and, as doctors, continue to ask ourselves what risk we consider acceptable in cost reduction. In this study we show that we have to administer a transfusion on average 14 times to prevent bleeding once. So, the question is what the prevention of bleeding is worth. That is really a consideration that will have to be made every time,” says medical researcher Floor van Baarle.

A CVC is also frequently utilized in the treatment of hematology patients, however patients with hematological problems have a completely different reason of low platelet count than patients in the ICU.

“In hematology patients, the production of platelets is disrupted by the disease or by chemotherapy, while most ICU patients do produce platelets, but they are immediately consumed. Our study shows that placing a CVL without a preventative platelet transfusion as a precaution leads to more bleeding in hematological patients than in ICU patients,” says lead researcher and hematologist Bart Biemond.

“The great thing about this research project is the joint effort of two different disciplines, with hematological and ICU patients and doctors. In this study, we show that the cost-benefit assessment can work out differently for different patients and that is very valuable information.”

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