Bloodless medicine programs have been formed in hundreds of leading hospitals around the globe in the last 20 years. Initially established to meet the needs of patients who decline transfused blood for religious or personal reasons, as healthcare consumers become more educated a growing number of patients are now requesting care without the use of donated blood whenever possible.
What lessons in blood management have we learned during the past two decades?
Transfusion triggers have been lowered.
In 1998 the “10/30 rule” (i.e., RBC transfusion indicated below a hemoglobin concentration of 10 g/dL or a hematocrit of 30%) was standard in most hospitals. “There is now increasing evidence that RBC transfusions are associated with adverse outcomes and should be avoided whenever possible.” 1
Most hospitals now use a transfusion trigger of around 8 g/dL hemoglobin.
The value of treating pre-operative anemia is more recognized
Studies have indicated that nearly 50% of patients entering an OR may be anemic at the time of incision.
An article in The British Medical Journal stated “Previously undiagnosed anaemia is common in elective orthopaedic surgical patients and is associated with increased likelihood of blood transfusion and increased perioperative morbidity and mortality. Anaemia should be viewed as a serious and treatable medical condition, rather than simply an abnormal laboratory value.” 2
It is important to know your hemoglobin level, just like you know your cholesterol and blood pressure numbers.
Many hospitals are moving toward patient blood management
An advisory committee of the US Department of Health and Human Services issued a letter in 2011 that stated, in part, “Blood transfusion carries significant risk that may outweigh its benefits in some settings and add unnecessary costs. Improvements in rational use of blood have lagged behind improvements in the quality and safety of the products.” 3
Organization-wide patient blood management incorporates lessons learned in managing the care of bloodless medicine patients into improved care for all patients.
- Anemia and perioperative red blood cell transfusion: a matter of tolerance. Crit Care Med 2006 May;34 (5 Suppl):S102-8. PMID:16617252
- Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines Br. J. Anaesth. (2011) 106 (1): 13-22. doi: 10.1093/bja/aeq361
- US Department of Health and Human Services Advisory Committee on Blood Safety and Availability www.hhs.gov/ash/bloodsafety/advisorycommittee/recommendations/reommendations_201106.pdf