The infectious risks of transfusions in the United States: a decision-analytic approach.
BACKGROUND
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.


METHODS
This study uses a decision-analytic model.


RESULTS
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.


CONCLUSIONS
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.
Heymann
S J
SJ
Harvard School of Public Health, Boston, MA.
Brewer
T F
TF
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality / Q000635:transmission; D000740:Anemia / Q000401:mortality / Q000628:therapy*; D001293:Attitude to Death; D001803:Blood Transfusion / Q000592:standards*; D003661:Decision Support Techniques; D017707:Erythrocyte Transfusion; D006679:HIV Seropositivity / Q000635:transmission; D006526:Hepatitis C / Q000401:mortality / Q000635:transmission; D006801:Humans; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D065227:Transfusion Reaction; D014481:United States