Heymann S J, Brewer T F
Harvard School of Public Health, Boston, MA.
Am J Infect Control. 1993 Aug;21(4):174-82. doi: 10.1016/0196-6553(93)90028-3.
The development of AIDS as a result of HIV transmission and of cirrhosis as a result of chronic non-A, non-B hepatitis are the greatest infectious risks associated with transfusion in the United States. The goal of this study is to provide explicit quantitative guidelines to determine when the risk of death from all causes associated with transfusion exceeds the risk associated with anemia.
This study uses a decision-analytic model.
On the basis of reported transfusion complication rates and an independent worst-case calculation of the risk of AIDS and non-A, non-B hepatitis, transfusion with red blood cells should be recommended as long as each unit received reduces the patient's risk of dying from anemia by at least 1/1100.
Because of the relative safety of the blood supply as a result of universal screening and donor deferral, the overestimation in practice of fatal infectious complications, and the possible underestimation of the risk of anemia, undertransfusion has the potential to be as serious a problem in the United States as is overtransfusion. Although caution should be exercised not to undertransfuse when a patient has an appreciable risk of anemia-associated death, we must be wary not to overtransfuse for temporary relief of morbidity.
在美国，因艾滋病毒传播导致的艾滋病以及因慢性非甲非乙型肝炎导致的肝硬化是与输血相关的最大感染风险。本研究的目的是提供明确的定量指导原则，以确定与输血相关的全因死亡风险何时超过与贫血相关的风险。
本研究使用了决策分析模型。
根据报告的输血并发症发生率以及对艾滋病和非甲非乙型肝炎风险的独立最坏情况计算，只要每输入一个单位的红细胞能使患者死于贫血的风险降低至少1/1100，就应建议进行红细胞输血。
由于普遍筛查和献血者延期使得血液供应相对安全，实际中对致命感染并发症的高估以及对贫血风险的可能低估，在美国，输血不足有可能成为与输血过量同样严重的问题。尽管当患者有明显的贫血相关死亡风险时应谨慎避免输血不足，但我们也必须警惕为暂时缓解病情而过度输血。
