Are Deaths by Blood Transfusion Common?

"Patients who received blood transfusions had higher rates of heart attack, heart failure, stroke, and even death."  -Duke Med News Oct 8. 2007

How often does death by blood transfusion occur?
To find an exact answer to this question is extremely difficult. Hours spent searching the internet results in an amazing array of statistics on blood transfusions. Interestingly, among all the vast numbers available, little is said about the actual numbers of transfusion related deaths (and when figures are presented they are generally limited to immediate death in the hospital due to a "fatal transfusion reaction" and not to deaths that occur weeks, months or years later. Emerging data reveal that reactions to blood transfusion include delayed death or, as it is more commonly referred to, post-surgical mortality*.) 

"Five-year mortality was more than twice as high in those who received perioperative blood transfusions than in those who did not."  -Pulmonary Reviews.com This quote highlights the fact that transfusion deaths cannot alone be measured by the numbers who may die in the hospital due to a "fatal transfusion reaction." An article written years ago estimated that of 70 million units transfused in a seven-year period, the number of deaths was rare.

In sharp contrast to that statement the United States Congressional Record stated this some years ago: "The Centers for Disease Control has stated that the actual rate of hepatit[i]s may be well in excess of the official figure due to the failure of many physicians to report serum hepatit[i]s cases. The center estimates that as many as 35,000 deaths and 500,000 illnesses a year may be due to the presence of serum hepatit[i]s in blood for transfusions." This statement originates with the Centers for Disease Control, a conservative organization not associated with alarmist statements.

Why would there be a failure of physicians to report these hepatitis related deaths? If physicians have a motivation to not report serum hepatitis cases would there be even greater motivation not to report deaths in hospitals due to other complications related to blood transfusions?

Statistics and the human reaction to them
If we lean toward the assertion that fatal transfusion reactions are rare, and tell ourselves, 'Well, it’s rare, I have a greater chance of getting struck by lightning,' then perhaps we need to ask ourselves, 'How will I feel when my son get’s struck by lightning?' At that time all the comforting statistics and the low odds go out the window. Especially when getting struck by lightning may not be preventable, but dying from a blood transfusion is.

Number of deaths due to blood transfusion
To return directly to the question - How often does death by blood transfusion occur? It’s difficult to say. Remember, "The Centers for Disease Control estimates that as many as 35,000 deaths and 500,000 illnesses a year may be due to the presence of serum hepatit[i]s in blood for transfusions." Let's assume this is an exaggeration and follow a hypothesis:

According to the World Health Organization, internationally, more than 81 million units of whole blood are collected annually.  If 80% of all collected blood is used for transfusion (not all blood collected is used for transfusion – but the greater number of units are) and four units of blood is the average number of units transfused then 16 million blood transfusions occur world wide annually. Divide that figure by 6,000 (a figure that some theorize is the death per transfusion ratio) and 2,700 people die annually. If two units of blood are the average, then 5,400 people die annually. However, this figure does not include the number of deaths that occur five, ten and fifteen years after a blood transfusion is given. (These numbers do not include post-surgical mortality figures.)

Making assumptions is treading on thin ice, and trying to deduce in one paragraph what the number of transfusion deaths are in the world is not really scientific. So why do it? Because nobody else seems to be doing it. In a world of endless data provided by governments and institutions - from the amount of peanut butter consumed by teenagers to the number of pounds of almonds produced in California - data on transfusion deaths is oddly very difficult to find.

However statistics on the number of ABO transfusion errors are known."For more than 25 years, ABO transfusion errors in the United States have caused more noninfectious transfusion deaths each year than any other cause. The US ABO error rate is between 1:12,000 and 1:19,000, with a fatality rate between 1:800,000 and 1:1.3 million.” Kathleen Sazama, Md, JD. (Dr. Sazama is president-elect of the Society for the Advancement of Bloodless Medicine - the world's leading association of Bloodless Medicine Professionals.)

So, while we may have some idea of how many patients have died due to human error we have less of an idea of how many have died from blood itself.

Such important data should be easy to find. It isn't. Interestingly, when the FDA investigates a new drug to be introduced to the public the data on fatal reactions is s key piece of critical information needed - information that needs to be verified, checked and double checked before FDA approval is given.

The FDA has never taken the same step with blood. Why not? Because blood is not a drug and is not regulated by the FDA. As Dr. Spiess said, "Transfusion has… never been FDA-tested." Bruce Spiess, Anesthesiologist and Transfusion expert - Virginia Commonwealth University Medical Center

Blood is not regulated and scrutinized (as are pharmaceutical drugs) anywhere in the world. So data on death due to transfusions are difficult to find. MyBlood welcomes any hard data to further our knowledge of this difficult subject.

Transfusion related post-surgical mortality
Remember the "five-year mortality was more than twice as high in those who received perioperative blood transfusions than in those who did not."

The following quotes link the reader to research that exposes the post-surgical mortality risk associated with blood transfusions.

    "Patients who were given a transfusion had significantly higher mortality in intensive care and overall mortality than patients who weren’t."  -British Medical Journal

    "In a large retrospective cohort study on 78,974 patients with acute myocardial infarction, transfusion was related to a reduction in 30-day mortality for patients if the haematocrit on admission was <33%. Conversely, transfusion was related to an increased mortality for patients with haematocrit >36%."  -oxfordjournals.org

    "Mistransfusion occurs in 1:14,000–1:18,000 cases, with an approximate morbidity and mortality rate of 1:600,000. Approximately 50% of the errors occur at the clinical level and Your browser may not support display of this image. 30% in the laboratory."  -oxfordjournals.org

    "Researchers examined the death rate of 4,073 patients with ST-elevated myocardial infarction 30 days after the heart attack occurred. Among the 363 patients who received transfusions, the post-heart attack death rate after 30 days was 13 percent, compared to just five percent for the 3,710 non-transfused patients. After adjusting for baseline characteristics, transfusion was still associated with higher mortality."  -Science Daily

    "An epidemiologic survey of 3,534 patients in 146 western European ICUs, confirmed increased mortality rates (ICU and hospital) in transfused patients."  -The Journal of the Society of Anesthesiologists Vol. 108 January 2008

    "Five-year mortality was more than twice as high in those who received perioperative blood transfusions than in those who did not."  -Pulmonary Reviews.com

    "[For] patients who underwent coronary artery bypass grafting transfusion [is] associated with a 70% rise in five-year mortality."   -Timothy Begany - Blood Transfusion: Risks And Alternatives - Pulmonary reviews.com Vol. 9, No 2 Feb 2004

    "Women have a greater post-bypass surgery mortality risk than men."  -Mary A.M. Rogers, Ph.D.

Statistics and you
Perhaps the question most readers will ask is this, Forget everyone else - what are my chances of dying from a blood transfusion? And the answer is unclear. It depends on many factors impossible to equate, like – what country you live in, your age, the age of the blood transfused (the oldest blood is always transfused first and older blood loses its ability to transport oxygen very quickly), who was the donor and what was his lifestyle, and many other factors.

Perhaps another question is relevant, What are my chances of dying from Bloodless Surgery? That answer may be easier, They are much less than dying from a blood transfusion. 

Listen to the experts
"Blood transfusion has often been shown to reduce cancer survival."  -British Journal of Surgery Volume 89 June 2002

"There is evidence that blood transfusion is associated with an increased rate of tumor recurrence."  -S Motoyama et al Surgery Today 2002;32(11):951-8.

"Oncology is a very, very big blood user, especially of platelets."  -Dr. Susan Roseff, MD, Director of Transfusion Medicine, Virginia Commonwealth University

"The rate of in-hospital death increased by 8.5 percent each additional day the transfused blood had been on the shelf."  -New York Times, June 27, 2006 

"The cancer surgeon may need to become a bloodless surgeon."  -Dr. John S. Spratt, The American Journal of Surgery, issue of September 1986

"Patients who received blood transfusions had higher rates of heart attack, heart failure, stroke, and even death."  -Duke Med News Oct 8. 2007 

"Stamler led a 2004 study by Duke University researchers that analyzed clinical trials totaling more than 24,000 cardiac patients. It found that blood transfusions substantially increased the risk of both heart attacks and deaths in the 30 days following heart surgery."  -Science Central Archive

*More studies are proving that cancer recurrences, as one specific example, are higher in patients who receive blood than those who do not. Some of these cancers lead to an early death. How many is difficult to determine.