Why do we keep transfusing two units of blood at the same time if just one could be enough?
Keywords:
BLOOD TRANSFUSION, REFERENCE STANDARDS
Abstract
Blood transfusion has been identified as one of the most overused medical procedures in hospitalized patients. One strategy that would reduce the exposure of patients to blood is through the implementation of a single-unit regime for stable patients without bleeding and with symptomatic anemia. The decision to transfuse blood is complex and depends on several factors, in addition, the risks of transfusion must be weighed against the expected benefits. Transfusion of two units of blood at the same time is no longer considered a “standard” form of treatment for anemic patients without active bleeding. There is a great opportunity to reduce the overuse of transfusion and encourage single-unit transfusions.
References
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(26) Chantepie S, Mear J, Parienti J, Bazin A, Benabed K, Cheze S, et al. Blood transfusion in hematologic intensive care unit. Transfusion 2017; 57(2):296-302. doi: 10.1111/trf.13908.
(27) Carson J, Carless P, Hebert P. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2012; 4(4):CD002042. doi: 10.1002/14651858.CD002042.pub3.
(28) Heyes J, Kelly P, Monaghan K, Lawn M, Dhesi A, Mijovic A. A single unit transfusion policy reduces red cell transfusions in general medical in-patients. QJM 2017; 110(11):735-9. doi: 10.1093/qjmed/hcx150.
(29) Shih A, Liu A, Elsharawi R, Crowther M, Cook R, Heddle N. Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies. Transfusion 2018; 58(12):2841-60. doi: 10.1111/trf.14952.
(30) Thakkar R, Podlasek S, Rotello L, Ness P, Frank S. Two-unit red cell transfusions in stable anemic patients. J Hosp Med 2017; 12(9):747-9. doi: 10.12788/jhm.2806.
(2) Yang W, Thakkar R, Gehrie E, Chen W, Frank S. Single-unit transfusions and hemoglobin trigger: relative impact on red cell utilization. Transfusion 2017; 57(5):1163-70. doi: 10.1111/trf.14000.
(3) Bowman Z, Fei N, Ahn J, Wen S, Cumpston A, Shah N, et al. Single versus double-unit transfusion: Safety and efficacy for patients with hematologic malignancies. Eur J Haematol 2019; 102(5):383-8. doi: 10.1111/ejh.13211.
(4) Cass R, Blumberg N. Single-unit blood transfusion: doubtful dogma defeated. JAMA 1987; 257(5):628-9.
(5) Mintz P. Single-unit blood transfusions. N Engl J Med 1983; 309(10):614. doi: 10.1056/nejm198309083091015.
(6) Thomson A, Farmer S, Hofmann A, Isbister J, Shander A. Patient blood management - a new paradigm for transfusion medicine? ISBT Sci Ser 2009; 4:423-35. doi: 10.1111/j.1751-2824.2009.01251.x.
(7) Adams R, Lundy J. Anesthesia in cases of poor surgical risk: some suggestions for decreasing the risk. Surgery, Gynecology & Obstetrics. 1942; 74:1011-19.
(8) Hébert P, Wells G, Blajchman M, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340(6):409-17. doi: 10.1056/NEJM199902113400601.
(9) Lacroix J, Hébert P, Hutchison J, Hume H, Tucci M, Ducruet T, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 2007; 356(16):1609-19. doi: 10.1056/NEJMoa066240.
(10) Hajjar L, Vincent J, Galas F, Nakamura R, Silva C, Santos M, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 2010; 304(14):1559-67. doi: 10.1001/jama.2010.1446.
(11) Carson J, Terrin M, Noveck H, Sanders D, Chaitman B, Rhoads G, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011; 365(26):2453-62. doi: 10.1056/NEJMoa1012452.
(12) Villanueva C, Colomo A, Bosch A. Transfusion for acute upper gastrointestinal bleeding. N Engl J Med 2013; 368(14):1362-3. doi: 10.1056/NEJMc1301256.
(13) Robertson C, Hannay H, Yamal J, Gopinath S, Goodman J, Tilley B. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014; 312(1):36-47. doi: 10.1001/jama.2014.6490.
(14) Holst L, Haase N, Wetterslev J, Wernerman J, Guttormsen A, Karlsson S, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 2014; 371(15):1381-91. doi: 10.1056/NEJMoa1406617.
(15) Mazer C, Whitlock R, Fergusson D, Hall J, Belley-Cote E, Connolly K, et al. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med 2017; 377(22):2133-44. doi: 10.1056/NEJMoa1711818.
(16) Carson J, Guyatt G, Heddle N, Grossman B, Cohn C, Fung M, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 2016; 316(19):2025-35. doi: 10.1001/jama.2016.9185.
(17) Mueller M, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, et al. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA 2019; 321(10):983-97. doi: 10.1001/jama.2019.0554.
(18) Retter A, Wyncoll D, Pearse R, Carson D, McKechnie S, Stanworth S, et al. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol 2013; 160(4):445-64. doi: 10.1111/bjh.12143.
(19) Ferraris V, Davenport D, Saha S, Austin P, Zwischenberger J. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg 2012; 147(1):49-55. doi: 10.1001/archsurg.2011.790.
(20) Koch C, Li L, Duncan A, Mihaljevic T, Cosgrove D, Loop F, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34(6):1608-16. doi: 10.1097/01.CCM.0000217920.48559.D8.
(21) Santos A, Sousa A, Piotto R, Pedroso J. Mortality risk is dose-dependent on the number of packed red blood cell transfused after coronary artery bypass graft. Rev Bras Cir Cardiovasc 2013; 28(4):509-17. doi: 10.5935/1678-9741.20130083.
(22) Anthes E. Evidence-based medicine: Save blood, save lives. Nature 2015; 520(7545):24-6. doi: 10.1038/520024a.
(23) Podlasek S, Thakkar R, Rotello L, Fleury T, Demski R, Ness P, et al. Implementing a “Why give 2 when 1 will do?” Choosing Wisely campaign. Transfusion 2016; 56(9):2164. doi: 10.1111/trf.13664.
(24) Berger M, Gerber B, Arn K, Senn O, Schanz U, Stussi G. Significant reduction of red blood cell transfusion requirements by changing from a double-unit to a single-unit transfusion policy in patients receiving intensive chemotherapy or stem cell transplantation. Haematologica 2012; 97(1):116-22. doi: 10.3324/haematol.2011.047035.
(25) Ma M, Eckert K, Ralley F, Chin-Yee I. A retrospective study evaluating single-unit red blood cell transfusions in reducing allogeneic blood exposure. Transfus Med 2005; 15(4):307-12. doi: 10.1111/j.0958-7578.2005.00592.x.
(26) Chantepie S, Mear J, Parienti J, Bazin A, Benabed K, Cheze S, et al. Blood transfusion in hematologic intensive care unit. Transfusion 2017; 57(2):296-302. doi: 10.1111/trf.13908.
(27) Carson J, Carless P, Hebert P. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2012; 4(4):CD002042. doi: 10.1002/14651858.CD002042.pub3.
(28) Heyes J, Kelly P, Monaghan K, Lawn M, Dhesi A, Mijovic A. A single unit transfusion policy reduces red cell transfusions in general medical in-patients. QJM 2017; 110(11):735-9. doi: 10.1093/qjmed/hcx150.
(29) Shih A, Liu A, Elsharawi R, Crowther M, Cook R, Heddle N. Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies. Transfusion 2018; 58(12):2841-60. doi: 10.1111/trf.14952.
(30) Thakkar R, Podlasek S, Rotello L, Ness P, Frank S. Two-unit red cell transfusions in stable anemic patients. J Hosp Med 2017; 12(9):747-9. doi: 10.12788/jhm.2806.
Published
2021-03-31
How to Cite
1.
Berro M, Rodríguez I. Why do we keep transfusing two units of blood at the same time if just one could be enough?. Rev. Méd. Urug. [Internet]. 2021Mar.31 [cited 2024Dec.16];37(1):e37112. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/677
Section
Opinion articles
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