Blood transfusions routinely carried out after heart surgery could be wasting vital blood supplies and putting patients at risk, researchers suggest.

Cardiac surgery uses almost ten per cent of all donor blood in Britain. Although the benefits of red-cell blood transfusions for managing life-threatening bleeding are clear, researchers at the University of Bristol believe that routine transfusions given after cardiac operations may be unnecessary and cause more medical problems than they solve.

Most decisions to transfuse after surgery are made on the basis of a patient’s haemoglobin level, regarded as a measure of the blood’s ability to deliver oxygen around the body.

The level of haemoglobin that causes a doctor to transfuse varies widely and research in non-cardiac surgical fields has shown that lowering the level that “triggers” transfusion reduces the chance of developing deadly infections, blood clots or kidney failure as well as the use of blood, they suggest.

The new research, funded by a £1 million grant from the National Institute for Health Research Health Technology Assessment (NIHR HTA), will examine if withholding blood transfusions until a patient reaches a lower haemoglobin threshold will improve the outcome for cardiac surgery patients and also reduce hospital costs.

Gavin Murphy, a senior lecturer in cardiac surgery at University Hospitals Bristol NHS Foundation Trust, who will lead the study, said: “Unnecessary blood transfusions increase healthcare costs both directly, because blood is an increasingly scarce and expensive resource, and indirectly, due to complications associated with transfusion.

“Transfusion may cause complications by reducing patients’ ability to fight off infection and respond to the stress that surgery puts on the body, as well as [rarely] by transmitting viral infections present in donor blood.”

The research will take the form of a randomised controlled trial at several hospitals across the UK. Patients identified from both outpatient and in-patient waiting lists will be invited to take part before surgery takes place.

Barnaby Reeves, Professorial Research Fellow in Health Services Research at the University of Bristol, said: “The primary outcome will be the number of patients affected by sepsis, stroke, heart attack or kidney failure during the first three months after surgery.

“We believe that withholding transfusion until the lower haemoglobin level is reached will reduce both complications and hospital costs.”

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