Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Blood transfusions increase mortality of hospitalized heart patients

06.10.2004


Heart patients are more than twice as likely to die during their first 30 days of hospitalization if they receive a blood transfusion to treat blood loss or anemia, according to a new analysis by cardiologists at the Duke Clinical Research Institute (DCRI).

Additionally, such patients are more than three times as likely to suffer a heart attack within 30 days, when compared to those who did not receive a transfusion.

These findings -- which emerged after a retrospective analysis of the treatments received by more than 24,000 patients hospitalized with an acute coronary syndrome -- run counter to earlier and smaller observational studies. For this reason, the researchers believe that a large randomized clinical trial needs to be initiated to resolve the issue and provide clear evidence-based guidance on how best to treat these patients. "Until such a trial can be conducted to resolve the differences between our study and past studies, we suggest caution in the routine use of blood transfusion for heart patients who are stable," said Duke cardiologist Sunil Rao, M.D., lead author of a study. For example, Rao said that cardiologists should not automatically order blood transfusions for anemic patients. The study results will be published Oct. 6, 2004, in the Journal of the American Medical Association. "The risks of transfusion remained even after we statistically controlled for other factors, such age, other illnesses and timing of the transfusions."



This issue is an important one, the researchers said, since cardiologists are now more aggressive in the treatment of patients who come to the hospital with symptoms of a heart attack. Physicians will often use clot-busting drugs or angioplasty procedures in an attempt to quickly re-open clogged arteries and save at-risk heart muscle. These treatments, as well as the routine drawing of blood for laboratory tests during hospitalization, can often leave patients with blood loss or anemia, a condition marked by decreased levels of oxygen-carrying red blood cells. "Many physicians, upon learning that their heart patients are anemic, will reflexively order a blood transfusion, believing that the additional red blood cells will deliver more oxygen to the heart and other tissues," Rao said. "However, there is data to suggest that oxygenation of the tissues do not necessarily increase as a result of blood transfusion."

The better understand the effects of transfusion on patient outcomes, the research team pooled the medical data from three large randomized clinical trials involving patients with acute coronary symdromes. Of the combined 24,111 patients, 10 percent (2,401) received at least one blood transfusion during the first 30 days of their hospitalization. The researchers found that in general, the patients receiving transfusions were older and had more additional medical problems.

Since the original clinical trials were not specifically designed to study the effect of transfusion, the researchers used three different statistical approaches in analyzing any associations between transfusions and adverse outcomes. All came to the same conclusions.

Specifically, the researchers found that 8 percent of transfused patients had died after 30 days, compared to 3.08 percent for those who did not receive a transfusion. Heart attacks occurred in 25.16 percent of those receiving additional blood, compared to 8.16 percent for those who did not. "The results of our analysis suggest that physicians should look at the whole patient, and not just the blood count number, when considering whether or not to transfuse someone," Rao said. "If patients appear to be fine, except for an abnormal blood number, it is probably best to hold off on transfusion. The body is constantly replenishing its blood supply, so in these patients it may be best to follow them to see if they can raise their blood counts on their own. If they don’t, then the physician should investigate potential underlying causes why the patient’s body isn’t responding."

According to Rao, the causes underlying the increased incidence of adverse events after transfusion are unclear. Previous studies have shown that transfused blood increases oxygen delivery only in the most severely anemic patients. Also, nitric oxide is essential for delivery of oxygen from the hemoglobin in red blood cells to tissues. However, according to Rao, nitric oxide has a short half-life, so by the time stored blood has been transfused, the essential nitric oxide may have been depleted.

It is also possible, Rao continued, that the transfused blood may stimulate an immune response that can exacerbate already existing coronary artery disease. "All of these factors, taken together, may act to promote ischemia in the heart rather than mitigate it,’ he said.
Rao’s analysis was funded by the DCRI. The three trials from which data was collected were GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) IIb, PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) and PARAGON (Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network) B.

Additional Duke members of the team were: James Jollis, M.D., Robert Harrington, M.D., Christopher Granger, M.D., Kristin Newby, M.D., Lauren Linblad, Karen Piper, Jonathan Stamler, M.D. (also a Howard Hughes Medical Institute investigator) and Robert Califf, M.D. Other members of the team were Eric Topol, M.D., Cleveland Clinic; Paul Armstrong, M.D., University of Alberta; and David Moliterno, M.D., University of Kentucky.

Richard Merritt | EurekAlert!
Further information:
http://www.mc.duke.edu

More articles from Health and Medicine:

nachricht Using fragment-based approaches to discover new antibiotics
21.06.2018 | SLAS (Society for Laboratory Automation and Screening)

nachricht Scientists learn more about how gene linked to autism affects brain
19.06.2018 | Cincinnati Children's Hospital Medical Center

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Temperature-controlled fiber-optic light source with liquid core

In a recent publication in the renowned journal Optica, scientists of Leibniz-Institute of Photonic Technology (Leibniz IPHT) in Jena showed that they can accurately control the optical properties of liquid-core fiber lasers and therefore their spectral band width by temperature and pressure tuning.

Already last year, the researchers provided experimental proof of a new dynamic of hybrid solitons– temporally and spectrally stationary light waves resulting...

Im Focus: Overdosing on Calcium

Nano crystals impact stem cell fate during bone formation

Scientists from the University of Freiburg and the University of Basel identified a master regulator for bone regeneration. Prasad Shastri, Professor of...

Im Focus: AchemAsia 2019 will take place in Shanghai

Moving into its fourth decade, AchemAsia is setting out for new horizons: The International Expo and Innovation Forum for Sustainable Chemical Production will take place from 21-23 May 2019 in Shanghai, China. With an updated event profile, the eleventh edition focusses on topics that are especially relevant for the Chinese process industry, putting a strong emphasis on sustainability and innovation.

Founded in 1989 as a spin-off of ACHEMA to cater to the needs of China’s then developing industry, AchemAsia has since grown into a platform where the latest...

Im Focus: First real-time test of Li-Fi utilization for the industrial Internet of Things

The BMBF-funded OWICELLS project was successfully completed with a final presentation at the BMW plant in Munich. The presentation demonstrated a Li-Fi communication with a mobile robot, while the robot carried out usual production processes (welding, moving and testing parts) in a 5x5m² production cell. The robust, optical wireless transmission is based on spatial diversity; in other words, data is sent and received simultaneously by several LEDs and several photodiodes. The system can transmit data at more than 100 Mbit/s and five milliseconds latency.

Modern production technologies in the automobile industry must become more flexible in order to fulfil individual customer requirements.

Im Focus: Sharp images with flexible fibers

An international team of scientists has discovered a new way to transfer image information through multimodal fibers with almost no distortion - even if the fiber is bent. The results of the study, to which scientist from the Leibniz-Institute of Photonic Technology Jena (Leibniz IPHT) contributed, were published on 6thJune in the highly-cited journal Physical Review Letters.

Endoscopes allow doctors to see into a patient’s body like through a keyhole. Typically, the images are transmitted via a bundle of several hundreds of optical...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Munich conference on asteroid detection, tracking and defense

13.06.2018 | Event News

2nd International Baltic Earth Conference in Denmark: “The Baltic Sea region in Transition”

08.06.2018 | Event News

ISEKI_Food 2018: Conference with Holistic View of Food Production

05.06.2018 | Event News

 
Latest News

Graphene assembled film shows higher thermal conductivity than graphite film

22.06.2018 | Materials Sciences

Fast rising bedrock below West Antarctica reveals an extremely fluid Earth mantle

22.06.2018 | Earth Sciences

Zebrafish's near 360 degree UV-vision knocks stripes off Google Street View

22.06.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>