Health Care–Associated Infection After Red Blood Cell Transfusion: A Systematic Review and Meta-Analysis

Study Questions:

Does blood transfusion increase the risk of health care–associated infections?


The authors performed a meta-analysis of 21 randomized trials comparing restrictive versus liberal red blood cell (RBC) transfusion strategies. The main outcome measure was the incidence of health care–associated infection such as pneumonia, mediastinitis, wound infection, and sepsis.


The pooled risk of all serious infections was lower in the restrictive group (11.8%; 95% confidence interval [CI], 7.0%-16.7%) compared with 16.9% (95% CI, 8.9%-25.4%) in the liberal group. The risk ratio (RR) for the association between transfusion strategies and serious infection was 0.82 (95% CI, 0.72-0.95), with little heterogeneity. The number needed to treat with restrictive strategies to prevent serious infection was 38 (95% CI, 24-122). Restrictive transfusion was associated with a lower risk of infection even with leukocyte reduction (RR, 0.80; 95% CI, 0.67-0.95). There were no significant differences in the incidence of infection by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding, or for infants with low birth weight.


Among hospitalized patients, a restrictive RBC transfusion strategy was associated with a reduced risk of health care–associated infection compared with a liberal transfusion strategy.


This study adds to the growing data supporting benefits of restrictive transfusion policies. There is considerable variation in use of blood products among patients undergoing cardiac procedures (see Sherwood MW, et al., JAMA 2014;311:836-43), and while the safe threshold in cardiac patients remains to be defined, blood transfusion should only be prescribed when absolutely necessary.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Blood Transfusion, Heart Diseases, Outcome Assessment (Health Care), Incidence, Risk, Erythrocyte Transfusion, Platelet Transfusion, Sepsis, Angioplasty, Balloon, Coronary, Leukocytes

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