I started my career as a blood banker about 40 years ago. My job description was crystal clear at that time. My first, and most important task, was to ensure patient transfusion safety. This goal was accomplished with fail-safe patient blood typing and crossmatching of units intended for transfusion. My second important task was to help manage the blood inventory. This was accomplished by ensuring that there were a sufficient number of units in the blood bank based on anticipated need and also by limiting excessive and inappropriate physician blood orders. This latter task certainly had a flavor of clinical transfusion management but the clinicians usually got the product and number that they requested. Here's an excerpt of the description of a job candidate being sought by Santé Consultants that I received recently as an email:
Immediate Opening for a Manager of Blood Utilization/Patient Blood Management in the New York City region.
Santé Consulting has recently been retained by our client to conduct a nationwide search for a Manager of Blood Utilization and Patient Blood Management. Candidates must have MD, or MD, PhD degrees and be certified by the American Board of Pathology in Anatomic and Clinical Pathology or Clinical Pathology only, including Transfusion Medicine and Blood Banking....The job involves assistant directorial and management responsibilities of Transfusion Medicine laboratories; directorial and management responsibilities for the Medical Center Patient Blood Management Program; teaching pathology residents and conducting basic or patient-oriented translational research. The candidate will work closely with the Vice Chair of Clinical Pathology and Director of Blood Bank and Transfusion Service to expand and further modernize the Transfusion Medicine laboratories. This position reports to the Director of Blood Bank and Transfusion Services, and is responsible for directing the Patient Blood Management Program, and assisting in the direction of operations of the Blood Bank, Stem Cell and Immunogenetics laboratories of a major Academic Medical Center.
As described, the pathologist being sought reports to the Director of Blood Bank and Transfusion Services but focuses on blood utilization and patient blood management. This strikes me as being mainly about the why, what, who, and quantity questions relating to transfusion. The emergence of such a position strikes me as interesting. I don't mean to imply here that we did not pay attention to blood utilization four decades ago. We encountered frequent blood shortages that demanded blood management strategies, one example of which was the maximum surgical blood order schedule (MSBOS) (see: Hospitals Seek to Limit Blood Transfusions as a Cost-Saving Measure; Lower Blood Transfusion Rates as a Metric for High Quality Care; The Value of a Restrictive Blood Transfusion Strategy for Hospitalized Patients; Research that Transfusion of "Older" Blood May Be Harmful to Patients). However and to be honest, this blood inventory management tool was designed to limit the time that units of blood inappropriately aging in the OR blood refrigerators. The main idea was to primarily to limit inappropriate crossmatching rather than inappropriate transfusion. Most of our efforts regarding the inappropriate use of product was focused on platelet transfusions, either because the patient had developed immunity to them or to husband a scarce and expensive resource for patients who desperately need the product.
So why this new attention to blood management and utilization control? It's relates partly to the fact that, in some circles, blood transfusion is often deemed useless or even harmful to the patient (see: Avoiding Blood Transfusion as a Hospital Quality and Cost-Savings Measure; ). Secondly, younger physicians, and particularly surgeons, are now trained to use less or no blood. Lastly, blood and blood products are expensive. Curbing inappropriate use is one of the many facets of controlling the cost of healthcare.