Tag Archives: transfusion

Increase in ‘Unvaccinated’ Blood Requests

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JW Jacobs et al. Transfusion 2026;1–9. Open Access! Directed donations for unvaccinated blood: A departure from evidence-based medicine associated with clinical harm, resource waste, and oversight gaps in a two-year single-center series

Background: “Vaccination status cannot be verified through standard blood supply channels, patients seeking “unvaccinated” blood have increasingly resorted to directed donation from known donors…directed donations demonstrate higher rates of infectious disease marker reactivity compared with repeat community donors, particularly among first-time parental donors.25, 26“

Methods: This was retrospective review of directed donations (n=15 including 9 pediatric patients) received at Vanderbilt University Medical Center between January1, 2024 and December 31, 2025

Key findings:

  • Two patients clinically deteriorated in the setting of refusal of standard components
  • Two additional patients had surgical delay/cancellation with rescheduling associated with directed component availability

Conclusion by authors: “Directed donation pursued for “unvaccinated” blood concerns occurred across pediatric and adult settings in both elective and urgent clinical scenarios. These requests were associated with clinical deterioration, care delays, and resource inefficiencies when standard inventory products were refused.”

My take: Many families do not understand that directed donation is less safe than using the blood bank.

Fox News report on this article by M Rudy (4/13/26): More patients demand ‘unvaccinated’ blood, doctors warn of growing health risks

Transfusion strategy in acute GI bleeding

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A recent study shows that holding off on blood transfusions can improve survival with severe acute upper gastrointestingal bleeidng (NEJM 2013; 368: 11-21).  This finding is not unexpected as this has been shown in observational studies.  In addition, in critical care patients without acute GI bleeding, a restrictive approach to transfusions has also been beneficial.

This study which enrolled 921 patients (>18 years) assigned 461 to a restrictive transfusion strategy (transfusion if <7 g/dL or at discretion of physician) and 460 to a “liberal” strategy (transfusion if <9 g/dL).

In additon to fewer transfusions, the restrictive group had improved survival:

  • 225 in the restrictive group did not require a blood transfusion compared with 65 in the liberal group
  • Survival at 6 weeks: 95% in the restrictive group compared with 91% in the liberal group.  Hazard ratio 0.55 (confidence interval 0.33 to 0.92) –a 45% reduction in the relative risk of 45-day mortality.
  • Recurrent bleeding occurred in 10% of the restrictive group compared with 16% of the liberal group.
  • The patients with cirrhosis (and Child-Pugh class A or B) were most likely to benefit from a restrictive approach with hazard ratio of 0.30.  Child-Pugh class C did not have a benefit from a restrictive approach with hazard ratio of 1.04.  With the liberal approach, there was a higher portal-pressure gradient within the first five days.

The reasons for bleeding in this study included peptic ulcers in about 50%, and varices in 24%.  The other causes included Mallory-Weiss tears, erosisve gastritis/esophagitis, and neoplasms.

Why does giving less blood result in better outcomes?

  1. Transfusion may impair hemostasis in several ways.  It may result in abnormalities in coagulation properties.  It may counteract splanchnic vasoconstrictive response.  And, in those with cirrhosis, it can increase portal pressure (even in the presence of somatostatin).  All of these mechanims may increase rebleeding.
  2. In addition, systemic effects from transfusion can include circulatory overload and pulmonary edema.

Also (unrelated to this posting), a thoughtful comment to a recent post on FDA regulations was posted by Ben Gold (Can the FDA prohibit free speech? | gutsandgrowth).

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