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Comment & Response |

Red Blood Cell Transfusion Strategies and Health Care–Associated Infection

Tetsuji Fujita, MD1
[+] Author Affiliations
1Jikei University School of Medicine, Tokyo, Japan
JAMA. 2014;312(19):2041-2042. doi:10.1001/jama.2014.12313.
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To the Editor There are concerns about study selection and data extraction in the meta-analysis by Dr Rohde and colleagues,1 which demonstrated an association between a restrictive red blood cell transfusion strategy compared with a liberal transfusion strategy and the risk of serious nosocomial infections (risk ratio [RR], 0.82 [95% CI, 0.72-0.95]) and infections after orthopedic surgery (RR, 0.70 [95% CI, 0.54-0.91]). The study by Karam et al,2 which was included in the meta-analysis for assessment of the association of transfusion strategy and the risk of serious infections, is a subgroup analysis of stable, critically ill children enrolled in a randomized trial, Transfusion Requirements in the Pediatric Intensive Care Unit (TRIPICU) study,3 which compared a hemoglobin threshold of 7 g/dL with a threshold of 9.5 g/dL. As seen in Figure 2 in the article, the TRIPICU study was also included in the meta-analysis, so these data were included twice.

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April 2, 2014
Jeffrey M. Rohde, MD; Derek E. Dimcheff, MD, PhD; Neil Blumberg, MD; Sanjay Saint, MD, MPH; Kenneth M. Langa, MD, PhD; Latoya Kuhn, MPH; Andrew Hickner, MSI; Mary A. M. Rogers, PhD
1University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor
2Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
1University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor3VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor4VA Ann Arbor Health Services Research and Development Center of Excellence, Ann Arbor, Michigan5Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
3VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor4VA Ann Arbor Health Services Research and Development Center of Excellence, Ann Arbor, Michigan
1University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor3VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor
1University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor3VA Ann Arbor Medical Center/University of Michigan Patient Safety Enhancement Program, Ann Arbor5Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
JAMA. 2014;311(13):1317-1326. doi:10.1001/jama.2014.2726.
November 19, 2014
Mary A. M. Rogers, PhD
1Department of Internal Medicine, University of Michigan, Ann Arbor
JAMA. 2014;312(19):2042-2043. doi:10.1001/jama.2014.12319.
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