Transfusion Thoughts with Dr. Bobbie Sutton

We have known for decades that blood transfusion is a life-saving medical intervention.  Just ask any survivor of severe traumatic injury, a complicated surgical procedure, or cancer, where necessary chemotherapy slowed the body’s ability to replace oxygen carrying red blood cells, infection fighting white blood cells or hemorrhage stopping platelets:  Transfusion saves lives.  However, an accumulating body of data also shows that there are significant risks associated with transfusion, and in some circumstances, those risks may outweigh the benefits.  For example, a large meta-analysis of transfusion data published in early 2014 in the Journal of the American Medical Association found that a restrictive approach to transfusion, i.e., giving less blood rather than more, was safer for many patients.  These researchers found that the risk of serious hospital-acquired infection was lowered substantially among patients whose doctors ordered a blood transfusion at a lower hemoglobin level, compared with those whose caregivers used a higher cutoff [1].  For surgical patients, blood transfusion has been associated with more postoperative pulmonary and infectious complications, prolonged ventilator support, and higher mortality.

In response to these and other data, today there is broad recognition that we should improve overall  patient blood management.   Broadly defined, patient blood management is an evidence-based, multidisciplinary process that is designed to promote optimal use of blood products in the hospital.  This concept places patient safety first, and includes transfusing only when medically necessary, thus potentially reducing overall patient morbidity and mortality.  In the cost conscious medical environment of today, a secondary goal of blood management is reduction of costs associated with treating any adverse events we now understand could be associated with transfusion, as well as just not having to collect, process and transfuse as much blood.   

Throughout the state, many of the hospitals we serve have embraced patient blood management.   At one hospital, posters reminding physicians to carefully consider transfusion requests are prominently displayed in physician elevators and other areas.  At another, blood utilization and management data spanning several years was published as an abstract at the AABB 2013 national meeting, entitled  “Reducing Platelet and Red Blood Cell Utilization in a 325 Bed Hospital” [2; on display, 4^th floor, Main Lab TMF].   Dr. Bobbie Sutton, Medical Director of Blood Donor Services and Blood Bank Services at The Medical Foundation, has lectured about Blood Management to multiple groups regionally.  Dr Sutton is working with clinicians at facilities to update existing transfusion policies and better reflect these new ideas.    “The data is out there, and the time to act is now” she says.  “Having shared hospital transfusion criteria in our region as a readily available practice guide for all physicians is a big step in the right direction.  It should facilitate more appropriate blood utilization and transfusion data review.”

1.  Rohde JM, Kimcheff DE, Blumberg N et al.  Health Care-Associated Infection After Red Blood Cell Transfusion.  A Systematic Review and Meta-analysis.  JAMA 2014;311(13):  1317.

2.  SuttonBC, RobertsD, Wright M et al.  Reducing Platelet and Red Blood Cell Utilization in a 325 Bed Hospital.  2013 AABB National Meeting.  Poster AP1.