Heart surgery blood transfusions can double the risk of infection and increase the chances of a patient dying in hospital almost five-fold, a study has shown.
Researchers in the US who looked at almost 25,000 heart bypass patients found strong evidence of infection from donor blood.
Donor transfusions were associated with a doubling of hospital infection rates and a 4.7-fold increased likelihood of in-hospital death.
Infections were widespread across the urinary system, lungs, bloodstream, digestive tract and skin.
A significant number of cases involved Clostridium difficile. For every 1% increase in the frequency of blood transfusions, there was a 0.13% increase in predicted infection rates.
The minority of patients who had "autologous" transfusions, receiving stored supplies of their own blood instead of someone else's, fared far better, as did those who had no blood transfusion.
Donated, or "allogeneic" blood, was given to 83.9% of patients and only autologous blood to just 1.2%. Of the patients in the study, 16.2% suffered a hospital infection.
The infection rate for those receiving donor blood was 18% compared with 9.7% for patients only given their own blood, and just 6.6% when no transfusion was carried out.
All the patients were elderly with ages ranging between 65 and 74. They underwent coronary artery bypass grafts (CABG) at hospitals in Michigan between 2003 and 2006.
The operation uses a length of blood vessel taken from another part of the body to divert blood around a blocked or damaged coronary artery.
Study leader Dr Mary Rogers, from the University of Michigan, whose findings are reported in the journal BMC Medicine, said: "Clearly, blood transfusions are vital in the treatment of some conditions, such as life-threatening bleeding. However, over the past several decades a body of evidence has accumulated that indicates various adverse effects in patients who receive transfusions, particularly with exposure to allogeneic blood.
"The safety of patients undergoing CABG will likely be improved if hospitals institute interventions to reduce inappropriate use of blood transfusions in recipients of CABG."
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