The benefits and risks of red blood cell transfusions for patients with trauma and major bleeding might vary considerably based on a patient's predicted risk of death on arrival at a trauma centre.
This is according to new research published in this week's PLOS Medicine. The study by Pablo Perel, from the London School of Hygiene & Tropical Medicine, United Kingdom, and colleagues, suggests that trauma patients who have the highest predicted risk of death on arrival at a trauma centre receive the greatest benefit from red blood cell transfusions but for those with the lowest predicted risk of death at baseline red blood cell transfusion is associated with a higher chance of death.
The authors of the study used data from the CRASH-2 trial that evaluated the effect of tranexamic acid (which reduces blood loss) in patients with trauma, which included 20,127 trauma patients with significant bleeding from 274 hospitals in 40 countries. The authors evaluated the association between receiving red blood cell transfusion versus not receiving a red blood cell transfusion with deaths by all causes at 28 days post trauma. The findings were stratified by predicted risk of death based on clinical observations on arrival at the trauma centre.
The authors caution, "[o]ur study suggests that blood transfusion could be harmful for those patients whose predicted risk of death is low. However, as our study was observational, important biases cannot be ruled out, and we cannot claim a causal link. Therefore, this hypothesis should be prospectively evaluated in a randomised controlled trial."
In an accompanying Perspective article PLOS Medicine Consulting Editor Druin Burch notes, "[w]ith so many dying each year, and with deaths from injury set to rise in importance as road traffic crashes and violent injuries account for a greater portion of the global burden of disease, we have a compelling reason to improve and rationalize our transfusion strategies."