A randomized controlled clinical trial to compare the clinical outcome of random-based versus formula-based blood transfusion in a tertiary care hospital setting

Background and objectives

Red cell transfusion is the mainstay of therapy for anemia and it is important to transfuse adequate dosage of red cells to maintain tissue oxygen demands. Additionally, it is also important to avoid overload of red cells to prevent adverse effects. Therefore, we compared the rise in hemoglobin and hematocrit for random-Based transfusion (RBT) and formula-based blood transfusion (FBBT) among patients to get a better understanding of differences in clinical outcome between the two methods.

Materials and methods

In this study 752 patients were included who were admitted in the hospital and required transfusion of a single unit of PRBC. Patients included in the study were randomized in two categories, RBT and FBBT, using stratified random sampling without any bias. In RBT category, patients received blood transfusion according to standard practice i.e. patient received the full red cell unit without any modifications in volume. All odd number request in cross-match register during the study period who fulfilled the eligibility were included in this group. In FBBT group, even numbered requests in the crossmatch register were randomized to receive FBBT. In this category, patients received transfusion according to the following formula:

Volume of PRBCs to be transfused = TBV × (Desired Hct − Current Hct of patient)/ Hct of donor unit (where the desired rise of Hct is 3%).

Results

In our study we found that the rise in hemoglobin and hematocrit levels were significantly higher for patients receiving FBBT as compared to the patients receiving RBT. Pre-transfusion hemoglobin and hematocrit did not have a significant difference whereas the post transfusion hemoglobin and hematocrit showed a higher rise in the FBBT group as compared to the RBT group. (Welch corrected t = 2.633, p value = 0.0086).

Conclusion

This study re-emphasizes the value of FBBT over the routinely used RBT. This study found that FBBT had an edge over RBT, providing significantly higher increase in post-transfusion Hb and Hct. The authors therefore are of the opinion that use of FBBT may be considered in routine clinical practice to optimize transfusions for the patients.