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Did you know that a considerable proportion of transfusion events are likely unnecessary? If you answered no, you are not alone. A recent study of transfusions in 15 hospitals found that more than 90% of patient transfusion encounters involved at least 1 unnecessary transfusion, and that almost half could have been managed without transfusion at all. And yet hospitals in the study believed they were following appropriate guidelines for limiting transfusion.1
Further, we know from clinical data that, conservatively in the United States, 50% to 60% of red blood cells, and 90% of plasma transfusions, are given when there is no need for them.2,3
Transfusion is expensive and carries significant risks, and unnecessary and avoidable transfusion is associated with increased lengths of hospital stay and overall poorer clinical outcomes. The recognition that transfusion is vastly overused, and that there are often better treatment options, is part of the revolution in patient blood management (PBM) that has occurred over the past 2 decades. In a recent Policy Brief, the World Health Organization called the implementation of PBM programs an “urgent need.”4
A comprehensive PBM program is the key to ensuring that patients avoid transfusions they don’t need but rather receive therapies that treat the underlying problems in patients’ own blood health, including anemia, bleeding, and coagulation problems. Modalities that focus on addressing the problems with the patient’s own blood, such as iron infusions or medications and devices that reduce unnecessary blood loss, have been shown to dramatically reduce the utilization of blood components.
A PBM program can be a catalyst for change when it comes to standardizing the care of patients and donors. An appropriate program can mitigate the impact of blood shortages, reduce transfusion-related costs (up to 30% over 3 years), improve outcomes by reducing adverse events, and decrease hospital stays and readmissions.5
A mature PBM program begins with the recognition that blood is the body’s liquid organ. Like the liver or the kidney or the heart, the goal should be to do everything possible to preserve it, to optimize it, and to keep it healthy. Transfusion should be the last resort, not the first option for patient care.
Despite the central importance of blood management, physicians in training receive remarkably little instruction in modern blood management decision-making. There is so much more than “7 g/deciliter,” the hemoglobin value that typically triggers a transfusion of red cells. Factors to consider include the clinical presentation, comorbidities, type and extent of anemia or bleeding, medical treatment options, and more.
The best PBM program is multi-pronged, coordinated, and evidence-based. It begins with evidence-based transfusion guidelines and electronic medical record orders, with intelligently created clinical decision support. But that’s only the beginning. Clinical education and awareness campaigns are critical for generating the underlying recognition that there is a better way to make decisions, so that when confronted with a patient in need of treatment, the physician brings lessons from the PBM initiatives to the decision-making process in real time. Further along, PBM includes metrics, analytics, and benchmarks to allow continuous improvement. Crucially, PBM also includes comprehensive bleeding mitigation strategies and anemia management, as well as therapies to reduce diagnostic blood loss.
The best PBM program offers the patient the best care and the hospital significant cost savings that pays for itself many times over in reduced direct costs and better patient outcomes. Ethically, clinically, and financially, a mature patient blood management program should be at the heart of every hospital’s approach to handling this most precious resource—the patient’s own blood.
