Association of Blood Transfusion with Increased Mortality in Myocardial Infarction

Background: The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists. Methods: A systematic search of studies published between January 1, 1966, and March 31, 2012, was conducted using MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. English-language studies comparing blood transfusion with no blood transfusion or a liberal vs restricted blood transfusion strategy were identified. Two study authors independently reviewed 729 originally identified titles and abstracts and selected 10 for analysis. Study title, follow-up period, blood transfusion strategy, and mortality outcomes were extracted manually from all selected studies, and the quality of each study was assessed using the strengthening Meta-analysis of Observational Studies in Epidemiology checklist.

Conclusions: Blood transfusion or a liberal blood transfusion strategy compared with no blood transfusion or a restricted blood transfusion strategy is associated with higher all-cause mortality rates. A practice of routine or liberal blood transfusion in myocardial infarction should not be encouraged but requires investigation in a large trial with low risk for bias. As evidence by this study, blood transfusions may have many consequences. All nurses performing blood or blood product transfusions must be current on their knowledge of possible reactions and treatments. Early identification of these various transfusion reactions is imperative for the safety of the patient.

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