New guidelines for life-saving blood transfusions based on Rutgers research

October 12, 2016

Most patients who need blood transfusions - including those who are critically ill - can be given blood when their hemoglobin drops to a lower level than practiced traditionally, according to AABB, a national association of blood banks that based its recommendation on research led by Rutgers University.

The new guidelines, published by The Journal of the American Medical Association (JAMA), were developed after Jeffrey L. Carson, professor of medicine at Rutgers Robert Wood Johnson Medical School, and an international team of scientists and doctors conducted comprehensive research using more than 60 years of red blood cell transfusion data and 31 clinical trials that examined outcomes of more than 12,500 individuals who received transfusion at lower (restrictive) verse higher (liberal) thresholds.

"Clinically, these results show that no harm will come from waiting to transfuse a patient until the hemoglobin level reaches a lower point," said Carson, first author of the paper and co-chair of the AABB guideline panel. "The restrictive approach is associated with reductions in blood use, blood conservation and lower expenses."

In the United States, an estimated 5 million people receive transfusions each year, according to the Centers for Disease Control and Prevention. They include surgery patients; accident, burn and trauma victims; mothers and babies during and after childbirth; and others whose blood counts reach low enough levels to threaten their lives. The guidelines recommend initiating a transfusion at a lower level than has been indicated in past practice.

AABB (formerly the American Association of Blood Banks) said based on the new evidence transfusions at a lower level are recommended for critical care patients as well as those undergoing orthopedic and cardiac surgery, and those with pre-existing cardiovascular disease. Further clinical trials are needed to determine whether heart attack patients with anemia or those with a bone marrow disorder benefit from transfusion at higher hemoglobin levels, Carson said.

"We are about to embark on a large international clinical trial supported by the NIH that will provide the evidence needed to determine the best course of action for patients who have had a heart attack," said Carson.

The new guidelines also include a second recommendation as a result of research that blood stored under standard conditions - up to 42 days - is just as safe as new blood which is less than 10 days old. According to Aaron Tobian, associate professor of pathology at Johns Hopkins University and co-chair of the AABB guidelines panel, "one of the biggest controversies in transfusion medicine is whether blood that is stored longer is harmful."

Carson, Tobian and colleagues from throughout the United States and Canada were involved in the guideline development that says transfusion medicine has significantly advanced the science in recent years and provides high quality evidence needed to make these recommendations.

Carson has been examining this issue for the past 25 years. In 2011, Carson's research published in the New England Journal of Medicine, which demonstrated the safety of few transfusions in the short term - 60 days- was one of the driving forces behind a change in blood transfusion practice nationally.

Guidelines are important because physicians performing surgeries and other procedures decide when a transfusion is needed, how much blood is needed based on how much blood the patient has lost and by closely watching vital signs such as low blood pressure.

"It is important for physicians and patients to know that these recommendations are based on high quality clinical evidence," said Carson. "We need to promote guidelines based on what science reveals."

Rutgers University

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to