Patients do better with fewer blood transfusions

Hospitals should restrict their use of blood transfusions with critically ill patients as this will probably increase their chances of surviving.

A significant paper, which may change the transfusion policy in hospitals, discovered that fewer patients died when they were given a restricted amount of transfused blood. Hospitals currently adopt a liberal policy where blood transfusions are given frequently.

A Canadian trial, known as TRICC (Transfusion Requirements in Critical Care), discovered that the death rate in the liberal transfusion group was 24 per cent, compared with 18 per cent in the restrictive transfusion group. In the liberal group, 101 patients died, compared with 77 patients in the restrictive group.

"That means, on average, one life was saved for every 17 patients transfused with the restrictive strategy," said Paul Hebert, the trial's prinicipal investigator.

Hebert said that 52 per cent fewer transfusions were given in the restrictive group, and transfusion was avoided altogether in one third of those patients. The bottom line, he said, is "less transfusion is better than more transfusion" (JAMA, 1998; 279: 1596-7).