Racial differences in red blood cell transfusion in hospitalized patients with anemia

Area of Science:

• Hematology
• Health Services Research
• Health Equity

Background:

• Transfusion guidelines recommend red blood cell (RBC) transfusions for hospitalized patients with hemoglobin (Hb) below 7 or 8 g/dL.
• Hospital transfusion policies aim to standardize care and reduce practice variation, yet disparities persist.
• This study investigated potential racial variations in RBC transfusion practices.

Purpose of the Study:

• To determine if patient race influences the likelihood of receiving RBC transfusions.
• To analyze racial differences in the number of RBC units transfused.

Main Methods:

• A cohort of 4,951 hospitalized general medicine patients with anemia (Hb < 10 g/dL) was analyzed.
• Chi-squared tests and linear regression models were used to compare transfusion rates and units by race.
• Analyses were stratified by nadir (lowest) hemoglobin levels.

Main Results:

• African American patients were less likely to receive RBC transfusions than White patients (25% vs. 30%, p < .01).
• This disparity persisted across various nadir hemoglobin strata, including levels below 7 g/dL.
• African American patients received fewer RBC units overall (β = -.17, p < .01) and at lower Hb levels (β = .14, p < .01).

Conclusions:

• Significant racial disparities exist in RBC transfusion practices.
• Patient race is associated with differences in both the receipt and quantity of RBC transfusions.
• Further research is needed to address these inequities in transfusion medicine.