Are We Transfusing Too Much Blood?

George D. Lundberg, MD

Would you be surprised if I said that nearly half of all blood transfusions administered in hospitals in the United States between 2012 and 2018 were unnecessary? A recent study used a sample of 15 community hospitals in five populous American states to examine nearly 7000 total adult transfusion events (approximately 100 encounters per hospital) by retrospective anonymized record review, using a blinded internal and external review process. The conclusion? Nearly half (44.6%) of the encounters could have been managed without any transfusion, and 54.6% could have been managed without at least one of the components. No examples of underutilization were found.

In the course of one recent year, 16 million units of blood or blood products were transfused in the United States. Is that how many units that should have been administered? Obviously, judgment is involved on a case-by-case basis. I do not know the answer.

But many authoritative figures and groups believe that far too many transfusions are administered. The Joint Commission names red blood cell transfusion as one of the top 5 overused hospital procedures. Five specialty societies list reducing unnecessary transfusions in their Choosing Wisely campaigns. Patient blood managementis an organized, systematic approach to best transfusion practices.