Blood transfusions found to harm some patients

A more recent study has found. For almost 9000 patients who had heart surgery in the UK between 1996 and 2003, receiving a red cell transfusion was associated with three times the risk of dying in the following year and an almost sixfold risk of dying within 30 days of surgery compared with not receiving one. Transfusions were also associated with more infections and higher incidences of stroke, heart attack and kidney failure - complications usually linked to a lack of oxygen in body tissues. "For heart-surgery patients in the UK, a red cell transfusion was associated with three times the risk of dying within the year" "There is virtually no high-quality study in surgery, or intensive or acute care - outside of when you are bleeding to death - that shows that blood transfusion is beneficial, and many that show it is bad for you," says Gavin Murphy, a cardiac surgeon at the Bristol Heart Institute, who ran the UK study. Organisations such as the American Society of Anaesthesiologists have started recommending that doctors be more conservative about ordering transfusions. But many experts worry that the recommendations are being ignored, and don't go far enough. Transfusion, they say, should only be used as a last resort, and far greater effort should go into preventing blood loss in the first place and ensuring patients are not anaemic before surgery. "Usually when there is any clinical uncertainty about a treatment you don't give it, but with transfusions we do," says James Isbister of the Royal North Shore Hospital in Sydney, who is an adviser to the Australian Red Cross Blood Service. A priority is to find out how transfusions can be harmful. One possibility is that they affect the patient's immune system. Blood transfusions are typically teeming with cytokines - chemicals that modify immune cells - and both the cytokines and white blood cells in donated blood have been shown to affect the action of "recipient" immune cells in the lab. Before modern immunosuppressant drugs were developed, blood transfusions were sometimes used to achieve immunosuppression during kidney transplants. Several of the recent studies have found an association between contracting infections in hospital and transfusions, which seems to support the theory. "The more units of blood patients receive, the more likely they are to get infections," says Mary Rogers at the University of Michigan in Ann Arbor, who has studied transfusions in US heart surgery patients. ...article continues here