Transfusion and long-term hemodialysis

We analyzed the transfusion practice at a large regional renal dialysis center. More than half of all long-term dialysis patients received at least one transfusion annually, and the average transfused patient received 10 U of blood. A review of data on 318 dialysis patients over one year showed there is a sizable group (15.0%) who require greater than ten transfusions of blood. This group of intensely transfused dialysis (ITD) patients account for a disproportionate 67% of all units transfused. The majority of these patients (73%) were women, which may have been related to the relatively small proportion (12.5%) of women undergoing dialysis who were treated with synthetic androgens. These ITD patients were older and underwent dialysis longer than others in the population studied. One year mortality in the ITD group was 27%; more than twice that of the entire group (12.8%). A retrospective examination of transfusion practice in the five years preceding the present study showed that the number of transfusion recipients was essentially a constant fraction of the dialysis population. However, there was a significant trend to less intense transfusion of each transfused patient. Most of the ITD group had significant iron overload, and attending physicians indicated that concern about transfusion related hemosiderosis outranked other reasons including acquired immunodeficiency syndrome, that would account for the more conservative transfusion practice of recent years.