Letters

Reducing blood transfusion

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7365.655 (Published 21 September 2002) Cite this as: BMJ 2002;325:655

BMJ's cover and headline exaggerated importance of study's findings

  1. Alain Vuylsteke (alain@vuylsteke.net), consultant in cardiothoracic anaesthesia and intensive care,
  2. Caroline Gerrard, surgical transfusion coordinator, anaesthetic research unit
  1. Papworth Hospital NHS Trust, Cambridge CB3 8RE
  2. Leeds General Infirmary, Leeds LS1 3EX
  3. Royal Infirmary of Edinburgh, Edinburgh EH3 9YW
  4. Medical Data Research Centre, Portland, OR, USA
  5. University of Wales College of Medicine, Cardiff CF14 4XN
  6. Institut für Transfusionsmedizin, 14770 Brandenburg an der Havel, Germany
  7. Institut für Medizinische Virologie, 35392 Gießen, Germany
  8. Friedrich Loeffler Institut für Medizinische Mikrobiologie, Universität Greifswald, 17489 Greifswald, Germany

    EDITOR—The randomised controlled trial on mechanical methods of reducing blood transfusion in cardiac surgery by McGill et al is laudable, but we challenge the BMJ for highlighting this paper on the front cover with the headline: “Cell salvage reduces the need for a transfusion.”1We believe that the journal has a responsibility not to exaggerate the perceived importance of findings, either in press releases or by other means.2


    Embedded Image

    Cell salvage reduces the need for transfusion

    (Credit: MAXIMILIAN STOCK LTD/SPL)

    View this table:

    Characteristics of consecutive patients who had elective first time coronary artery bypass graft surgery in Papworth with details of blood products received perioperatively. Values are means (SD) with ranges unless stated otherwise

    The authors themselves highlighted the main limitations of the study in their discussion, and we believe that such declarations are important safeguards against widespread use of the described methods without further scientific evaluation.

    The authors comment on the high cost of transfusion, but they did not include a cost analysis in their study. We understand the risks associated with transfusion and agree that these in themselves may justify any added cost. However, introducing strict transfusion guidelines and monitoring their use is certainly a step that should precede the introduction of new equipment.

    We have been reinforcing transfusion guidelines for the past two years in our institution and are continuously monitoring blood transfusion in our hospital. Interestingly, when looking at a similar patient population to that of McGill et al, but lacking the research methods and statistics, we have achieved a similar decrease in use of all blood products, mainly by insuring that blood is transfused only when required and blood products given when need is documented (table). Despite our programme, blood products are still administered too often outside the hospital guidelines, and we think that we could …

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