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Morbidity and Mortality after High-dose Transfusion.

Daniel J Johnson1, Andrew V Scott, Viachaslau M Barodka

  • 1From the Department of Anesthesiology and Critical Care Medicine (D.J.J., A.V.S., V.M.B., S.P., J.O.W., S.M.F.) and Department of Pathology (P.M.N., T.G.), The Johns Hopkins Medical Institutions, Baltimore, Maryland.

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Summary
This summary is machine-generated.

High-volume red blood cell transfusions significantly increase patient mortality and morbidity. Mortality rises with each unit transfused, with over 50% mortality after 50 units, highlighting transfusion dose as a critical factor.

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Area of Science:

  • Transfusion Medicine
  • Critical Care Medicine
  • Clinical Outcomes Research

Background:

  • Increased transfusion volumes correlate with higher morbidity and mortality.
  • Previous studies lacked dose-response data for high-volume transfusions.

Purpose of the Study:

  • To assess the dose-response relationship between transfusion volume and clinical outcomes.
  • To identify predictors of adverse outcomes in patients receiving high-dose transfusions.

Main Methods:

  • Retrospective analysis of 272,592 medical/surgical patients.
  • Focused on 3,523 patients receiving ≥10 erythrocyte units.
  • Dose-response curves generated for morbidity and mortality; comorbidities analyzed.

Main Results:

  • Infections and thrombotic events were 4-5x more common in high-dose transfusion patients.
  • Mortality increased linearly with transfusion dose (10% increase per 10 units).
  • Mortality exceeded 50% after 50 erythrocyte units; transfusion dose, comorbidity index, and heart failure history predicted mortality.

Conclusions:

  • High- or very-high-dose transfusions pose significant risks for hospital-acquired infections and thrombotic events.
  • Linear increase in mortality observed across the dose range.
  • Transfusion dose is a critical predictor of mortality in this patient population.