Blood transfusion regulations needed to rein in overuse: Panel

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(CBS/AP) Are doctors blood transfusion-happy? In the U.S., some docs are ordering blood transfusions for non-life-threatening conditions, risking patients' lives and reducing the nation's blood bank supplies.

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

Advisers to Health and Human Services Secretary Kathleen Sebelius said "there is both excessive and inappropriate use of blood transfusions in the U.S."

Blood banks are also on board with the need for guidelines, as they try to balance how to keep enough blood on the shelves without it going bad or running short.

"Better patient care is what's being advocated here," Dr. Benjamin said. "If a transfusion is not necessary, all you can do is harm."

The U.S. uses more than 14 million units of red blood cells a year. Between 1994 and 2008, blood use climbed 40 percent, Benjamin told the HHS Advisory Committee on Blood Safety and Availability. But parts of the country experience shortages each year as blood banks struggle to bring in enough donors to keep up.

Overall donation levels are good, but there's a big need for 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.

Studies highlight the unnecessary number of transfusions docs are doling out. One published last fall tracked more than 100,000 open heart surgery patients. Just 8 percent of them received transfusions at some hospitals, while a whopping 93 percent did at other hospitals. Survival wasn't significantly different at hospitals that used more blood than at hospitals that used less.

That's important, because transfusions can be risky. While the risk of transfusing blood infected with HIV or other viruses is rare compared to the past, people may experience allergic-style transfusion reactions and other potentially fatal complications.

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.

How can doctors avoid transfusions? HHS advisers urged the government to explore a "patient blood management" solution to determine when transfusions are avoidable.

At Eastern Maine Medical Center in Bangor, doctors order blood via a computerized form that warns if they're about to deviate from the guidelines and tracks who uses the most blood.

For example, patients are supposed to be checked for anemia before elective surgery - like a hip replacement - is scheduled, so they can be treated with iron or other therapies beforehand to lower the chances of a post-surgery transfusion. For non-surgery patients, other guidelines spell out when anemia 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. As a result of these measures, 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, according to the hospital's Transfusion Chief, Dr. Irwin Gross. He calculated that the hospital saved $5.4 million over four years in the cost of buying blood.

The Mayo Clinic has more on blood transfusions.

[nick401]

"The current literature pertaining to associated morbidity and mortality with homologous blood transfusion in the surgical patient seems to be pointing only in one direction, which is we must start reducing our patients exposure to homologous blood and products. There appears to be ever mounting evidence of increases in infraction, stroke, transfusion related lung injury, infection, and death that authors are associating with transfusion&"
http://www.ncbi.nlm.nih.gov/pubmed/21449243

[OGDave]

http://www.noblood.org/content/
Transfusions can mean big money for the hospitals. It is estimated that a single unit of packed red blood cells (PRBC's), with an acquisition cost of two hundred U.S. dollars ($200.00) has an actual cost of between one thousand six hundred ($1,600.00) and two thousand four hundred dollars ($2,400.00) to transfuse it to the patient. Most surgeries can be done without transfusions. Ronald Lapin (1941-1995) was a maverick Israeli-born American surgeon, best known as a "bloodless surgeon" due to his willingness to perform surgeries on severely anemic Jehovah's Witness patients without the use of blood transfusions. He completed medical school in New York City and established his practice in Orange County, CA, in the 1970s, where he lived until his death. He pioneered the use of the electric scalpel in such cases, which reduces blood loss during surgery. He promoted and taught the use of this and other techniques that make bloodless surgery successful. Lapin became interested in bloodless surgery in the mid 1970s, while practicing his profession in Orange County, CA. He was approached by a severely anemic Jehovah's Witness in need of surgery (who, due to religious beliefs, could not accept a blood transfusion). During this first operation on a Witness patient, Lapin secured the help of the anesthesiologist by assuring him that the blood needed for the operation was "on its way". After successfully performing that first surgery without the use of any transfused blood, Witnesses who heard of his rare cooperation came to him for help with their surgical needs. Thus was born his practice dedicated to providing bloodless surgery for Witness patients from around the world. He founded several bloodless surgery centers in Southern California, including hospitals in Norwalk, Bellflower, and Fountain Valley, and became a tireless advocate of non-blood medical management. In 1980, Lapin was chosen by a Japanese pharmaceutical firm to operate on Jehovah's Witness patients, with conditional FDA approval, using Flouisol DA, an "artificial blood" substitute. The unique oxygen-carrying properties of the product were the subject of a segment on the ABC television program "That's Incedible!". During the show, one of Lapin's patients, Donna Graham of Winchester, CA, was shown recovering from an emergency hysterectomy, having received approval for a transfusion of the "artificial blood" due to extreme loss of blood prior to admission. An unusual stunt on the program showed a mouse being immersed in the product, and yet, due to its blood being oxygenated via the fluid, it did not drown. After a tabloid newspaper accused the show of hiding the later death of the mouse, the stunt was repeated on another segment of the program. For publicly challenging conventional medical practices, which Lapin derided as substandard and unacceptable, he experienced persecution in the form of legal attacks and even sabotage. His story is recounted in the Gene Church biography No Man's Blood.[1]
Although Lapin's early advocacy of bloodless surgery was viewed as radical at the time, the outbreak of blood-borne AIDS infections helped the cause, and throughout the world today many hospitals gladly accept JW patients who have low hemoglobinm counts for a full array of procedures. Thanks in part to his efforts, surgeons routinely perform successful bloodless operations for all types of medical problems, from open heart surgery to hip replacement. There are even hospitals that openly seek such business; one such facility is Englewood Hospital and Medical Center in Englewood, New Jersey.