Groundbreaking research by Rutgers internist Dr. Jeffrey Carson has led to a major reversal in blood transfusion guidelines for a specific patient group: anemic heart attack victims. After decades of his own work advocating for a “less is more” approach to blood transfusions, Carson’s latest study shows that a more liberal transfusion strategy significantly improves outcomes for these patients.
Carson, a distinguished professor of medicine at Rutgers Robert Wood Johnson Medical School, is known for his earlier research that persuaded hospitals to adopt more restrictive transfusion protocols to conserve blood without compromising patient outcomes. However, his most recent work, published in the New England Journal of Medicine in late 2023, revealed a crucial exception.
The study, which has since been reinforced by a combined analysis of patient data from multiple trials, directly influenced updated guidelines from major medical organizations, including the American College of Cardiology, the American Heart Association, and the Association for the Advancement of Blood & Biotherapies (AABB). These new guidelines recommend that clinicians consider transfusing enough blood to keep hemoglobin levels near 10 g/dL for anemic heart attack patients, a significant increase from the previous standard of 7-8 g/dL.
Carson’s research found that this more liberal transfusion strategy could prevent approximately 4,800 recurrent heart attacks or deaths and 3,200 deaths annually among the 200,000 anemic heart attack patients in the United States. While this would require an extra 366,000 pints of blood per year—a little more than 3% of the total blood transfused nationwide—the potential to save thousands of lives makes the practice worthwhile.
The irony of Carson’s finding is not lost on him. “You go where the evidence leads and embrace the practices that will save lives,” he said. His research journey began in the 1990s, when he studied Jehovah’s Witness patients who refused transfusions. That initial work provided early clues that while most patients fared well with lower hemoglobin levels, those with serious heart conditions benefited from more blood.
Carson’s work in this field has been praised by his peers. Aaron Tobian, director of the Transfusion Medicine Division at Johns Hopkins Hospital, said, “Jeff has now changed clinical medicine twice in the past 25 years. He has had more influence on the way we transfuse these days than anyone else.”
