Too many blood transfusions? New standards urged

Jun 27, 2011 By LAURAN NEERGAARD , AP Medical Writer

(AP) -- Check into the hospital and you may get a blood transfusion you didn't really need.

There's a lot of variation around the country in how quick doctors are to order up a few pints - not in cases of trauma or where infusing blood fast can be life-saving, but for a range of other reasons.

Anemia is common in older patients, for example, who may get a transfusion as an easy boost even when the anemia's too mild to matter or instead of treating the underlying problem. Need open-heart surgery or another complex operation? There are steps surgeons could take to minimize instead of trying to replace it later.

Now a government advisory committee is calling for national standards on when a transfusion is needed - and how to conserve this precious resource.

All the variability shows "there is both excessive and inappropriate use of blood transfusions in the U.S.," advisers to Health and Human Services Secretary Kathleen Sebelius concluded earlier this month. "Improvements in rational use of blood have lagged."

Blood banks welcome the idea, important as they try to balance how to keep just enough blood on the shelves without it going bad or running short.

"Better patient care is what's being advocated here," says Dr. Richard Benjamin, chief medical officer of the American Red Cross. "If a transfusion is not necessary, all you can do is harm."

The U.S. uses a lot of blood, more than 14 million units of a year. Between 1994 and 2008, blood use climbed 40 percent, Benjamin told the HHS Advisory Committee on Blood Safety and Availability. In many years, parts of the country experienced spot shortages as blood banks struggled to bring in enough donors to keep up.

Surprisingly, blood use dropped a bit with the recession, roughly 6 percent over two years, Benjamin says. He couldn't say why. That dip has leveled off, but specialists say demand is sure to rise again in coming years as the population rapidly grays and people who once were prime donors become more ill and frail.

Right now, overall donation levels are good with one exception, Benjamin says: There's a big need for more Type O-negative blood, especially as banks prepare for the usual summertime donor drop. Few donors are Type O negative, but it's compatible with all other blood types and hospitals have begun using more of it in recent years.

What's the evidence for avoidable transfusions?

One study published last fall tracked more than 100,000 people who underwent open-heart surgery, a transfusion-heavy operation. Just 8 percent of those patients received transfusions at some hospitals, while a startling 93 percent did at other hospitals. But survival wasn't significantly different at hospitals that used more blood than at hospitals that used less.

That's important, because transfusions are not risk-free. While the risk of HIV or other viruses is very rare in blood today, people also can experience allergic-style transfusion reactions and other complications, sometimes fatal ones.

Another study last fall examined Medicare patients who received blood for various reasons over a 10-year period, and found those who live in the South are the most likely to get a transfusion and those who live in the West are the least likely.

Overall, the U.S. uses about 49 units of blood for every 1,000 patients, substantially more than Canada or Britain where those transfusion rates are in the 30s, Benjamin says.

One solution that the HHS advisers urged the government to explore: Some hospitals have begun what's called "patient blood management," instituting their own guidelines on when a transfusion is avoidable.

Consider Eastern Maine Medical Center. Transfusion chief Dr. Irwin Gross described how doctors now order blood via a computerized form that warns if they're about to deviate from the guidelines and tracks who uses the most.

Planning a hip replacement? Patients are supposed to be checked for anemia before elective surgery is scheduled, so they can be treated with iron or other therapies beforehand and lower chances of a post-surgery transfusion. For non-surgery patients, other guidelines spell out when is bad enough to warrant a transfusion or when a patient should just be monitored.

In cardiac and back surgeries, equipment captures a patient's own blood and pumps it back right away, reducing the need for post-surgery transfusions.

The program reduced the amount of blood drawn just for laboratory tests, and limited when doctors can order multiple transfusions rather than checking first to see if one did the trick.

The result: The Bangor hospital is giving blood to nearly half as many patients as it did in 2006, the year before the program began. And there are no signs of patient harm, Gross told the HHS committee. He calculated that the hospital saved $5.4 million over four years in the cost of buying blood.

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

not rated yet
add to favorites email to friend print save as pdf

Related Stories

Blood transfusions associated with infection

Jul 31, 2009

A study of almost 25,000 coronary artery bypass graft (CABG) patients has shown that receiving blood from another person is associated with a two-fold increase in post-operative infection rates. The research, published in ...

Blood transfusion study: Less is more

Aug 05, 2009

A new study suggests that blood transfusions for hospitalized cardiac patients should be a last resort because they double the risk of infection and increase by four times the risk of death.

Recommended for you

What are the chances that your dad isn't your dad?

Apr 16, 2014

How confident are you that the man you call dad is really your biological father? If you believe some of the most commonly-quoted figures, you could be forgiven for not being very confident at all. But how ...

New technology that is revealing the science of chewing

Apr 15, 2014

CSIRO's 3D mastication modelling, demonstrated for the first time in Melbourne today, is starting to provide researchers with new understanding of how to reduce salt, sugar and fat in food products, as well ...

After skin cancer, removable model replaces real ear

Apr 11, 2014

(HealthDay)—During his 10-year struggle with basal cell carcinoma, Henry Fiorentini emerged minus his right ear, and minus the hearing that goes with it. The good news: Today, the 56-year-old IT programmer ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

5 / 5 (1) Jun 28, 2011
Bravo blood donors!
Contact the Red Cross on line to find the location of a blood drive near you. Give the gift of life!

Jehovah's Witnesses blood transfusion confusion.
Estimates range from 100,000 to 250,000 JW including countless children that have perished since the 1940s when the no blood transfusion doctrine was enforced.
Simple fact-The Bible does not prohibit Blood transfusions.If you are bleeding to death it is more dangerous to refuse a blood transfusions than to take one.
Bloodless surgeries are great if they can be elective.1/3rd of all trauma deaths are from blood loss.
Watchtower society will not allow a Jehovah's Witness to pre store their OWN blood called autologous blood,yet allows the transfusion of so-called Hemopure made from Bovine cow's blood.
Danny Haszard

More news stories

Treating depression in Parkinson's patients

A group of scientists from the University of Kentucky College of Medicine and the Sanders-Brown Center on Aging has found interesting new information in a study on depression and neuropsychological function in Parkinson's ...