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Research Letter |

Decreased Red Blood Cell Use and Mortality in Hospitalized Patients

Nareg H. Roubinian, MD, MPHTM1; Gabriel J. Escobar, MD2; Vincent Liu, MD2; Marla N. Gardner, BS2; Jeffrey L. Carson, MD3; Steven H. Kleinman, MD4; Edward L. Murphy, MD5 ; for the NHLBI Recipient Epidemiology and Donor Evaluation Study (REDS-III)
[+] Author Affiliations
1Blood Systems Research Institute, San Francisco, California
2Division of Research, Kaiser Permanente Northern California, Oakland
3Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
4University of British Columbia, Victoria, British Columbia, Canada
5University of California, San Francisco
JAMA Intern Med. 2014;174(8):1405-1407. doi:10.1001/jamainternmed.2014.2889.
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Blood conservation strategies effectively decrease red blood cell (RBC) use in specific patient groups.13 However, the impact of RBC transfusion reduction on mortality in a diverse inpatient population remains poorly described. We detail the impact of declining RBC use on 30-day mortality within Kaiser Permanente Northern California (KPNC), an integrated health care delivery system serving 3.5 million members at 21 hospitals.

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Figure 1.
Trends in Inpatient RBC Use and Pretransfusion Hemoglobin Levels Across 21 KPNC Facilities

The number of RBC units transfused per 100 patients and median pretransfusion hemoglobin level decreased following initiation of blood conservation strategies in 2010 (P < .001). To convert hemoglobin to grams per liter, multiply by 10. KPNC indicates Kaiser Permanente Northern California; and RBC, red blood cells.

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Figure 2.
Inpatient RBC Transfusion Incidence and SMRs

The decline in RBC transfusion incidence in patients whose hemoglobin level fell below 10 g/dL (n = 218 056) was not associated with differences in SMRs in transfused and nontransfused patients. To convert hemoglobin to grams per liter, multiply by 10. RBC indicates red blood cells; and SMRs, standardized mortality ratios.

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