In a previous life in the 1970s, I was a blood banker at a large academic hospital. This may sound unbelievable to some of the current Lab Soft News readers but one of our cardiac surgeons in the 1970's would often transfuse six or more units of blood during a CABG (see: Variation in Use of Blood Transfusion in Coronary Artery Bypass Graft Surgery). Although modern blood transfusion can be life-saving, it can sometimes be a substitute for controlling hemorrhage by other and more appropriate means. In other words, less transfusion can often be equated with higher quality care. There is also a financial benefit when a hospital seeks to lower blood utilization rates. This point was reinforced in a recent article (see: Hospitals see improved outcomes, lower costs as blood transfusions drop). Below is an excerpt from it:
Hospitals across the country have been cutting back on their use of blood, saving them money and improving patient outcomes, according to a new study. Premier, the nation's largest group purchasing organization, found that since its last analysis in 2012 blood utilization has been cut nearly in half across the 10 procedures that use the most blood without compromising quality of care. Rates of mortality, complications and readmissions fell in that same timeframe. The GPO's nationwide analysis of 645 hospitals spanning 2011 through the first half of 2016 revealed a 20% decrease in blood utilization across 134 diagnoses that account for the vast majority of red blood cell use. The blood use cuts helped Mercy Health save $6.2 million over that time period, said [a health system executive] "We are conserving a scarce resource and improving patient care," he said....[R]esearchers have found that blood transfusions among cardiac surgery patients have been linked to increased risk of mortality. Transfusions, of which around 40% are unnecessary according to some estimates, can increase the likelihood of allergic reactions, fever, lung injury, immune suppression, iron overload and other harmful side effects. They can also drain a hospital's finances, as each unit of red blood cells costs $218, not accounting for overhead and transportation costs that can inflate the price nearly 5 times.
I hold the opinion that the skill of the physician managing a patient with a low or a rapidly declining hematocrit is critically important and better clinical management tends to result in less blood transfusion. These ideas are reenforced in a passage in Upto Date which is shown below (see: Indications and hemoglobin thresholds for red blood cell transfusion in the adult):
For many decades, the decision to transfuse red blood cells (RBCs) was based upon the "10/30 rule": transfusion was used to maintain a blood hemoglobin concentration above 10 g/dL (100 g/L) and a hematocrit above 30 percent....The 1988 National Institutes of Health Consensus Conference on Perioperative Red Blood Cell Transfusions suggested that no single criterion should be used as an indication for red cell component therapy, and that multiple factors related to the patient's clinical status and oxygen delivery needs should be considered....A common theme of...guidelines [for blood transfusion] is the need to balance the benefit of treating anemia with the desire to avoid unnecessary transfusion, with its associated costs and potential harms. This requires considerable diagnostic skill and acumen on the part of physicians ordering transfusions.
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