Jeffrey L. Carson, M.D.
Jeffrey L. Carson, M.D.
Professor, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
Transfusion Trigger Trial in Coronary Artery Disease: A Pilot Study
Administered by the NHLBI Division of Blood Diseases and Resources, Transfusion Medicine and Cellular Therapeutics Branch
FY 2009 Recovery Act Funding: $1,392,130
Research Focus: For Jeffrey L. Carson, M.D., his journey into exploring when patients should receive blood transfusions began when he faced patients who refused the procedure due to religious beliefs. Treating surgery patients who viewed accepting another person's blood as being against their religion started Dr. Carson wondering about the right circumstances to begin blood transfusions in surgical settings. "One of my first research projects was to examine the association between anemia and outcomes in surgical patients who declined transfusion," he explained. "This led to asking the question 'when should patients receive blood transfusion?'"
More than 14 million red blood cell transfusions are performed annually in the United States with 75 million such procedures taking place worldwide each year. While most health care providers view this as a common procedure, there is little evidence guiding when to administer transfusions in most clinical settings including after surgery and in patients with heart disease.
With money from the National Heart, Lung, and Blood Institute (NHLBI) through the American Recovery and Reinvestment Act (Recovery Act), Dr. Carson is launching the Myocardial Ischemia and Transfusion, or MINT, clinical trial. Participating patients are in study hospitals with heart attacks or pain from blocked blood vessels leading to the heart. These patients often have low hemoglobin levels from bleeding that results from heart tests or from blood-thinning medications used to treat the heart problem. Blood transfusions are performed to compensate for the low levels of hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen throughout the body.
Public Health Implications: The MINT study, which is a pilot program, will determine the differences between setting a transfusion trigger at one of two different hemoglobin levels. Healthy people have hemoglobin levels above 12, but those levels can fall dramatically after heart attack. Patients in one test group will receive transfusions if their hemoglobin level falls below 10, while the other test group will only receive transfusions when their hemoglobin level falls below eight. The study will help answer the question of the role of transfused blood in improving survival and preventing recurrent heart attacks among heart disease patients.
If there is little difference between the two practices, the findings could lead to health care savings through needing fewer units of blood and avoiding the associated expenses that come with transfusions. If one procedure leads to better long-term outcomes, it could help patients avoid future hospital visits due to later cardiovascular complications, including heart attacks or the need for surgery.
Economic Impact: The NHLBI Recovery Act-funded grant helped Dr. Carson's team pay for two full research positions as well as part-time positions. The funding will also help hire a research coordinator, who will recruit participants into the MINT trial over the next two years. "This funding is critical to continuing my work on the optimal transfusion trigger," he noted.
Dream Discovery: The MINT trial directly relates to what Dr. Carson's views as his ideal breakthrough discovery for his career. "I hope that my work will provide the critical evidence needed to guide the optimal use of blood transfusion," he said. That discovery would be an ideal closing chapter for this line of research to help improve blood transfusions that began with his caring for surgical patients who refused blood transfusions.
By Greg Lavine