Too many blood transfusions? New standards urged

Posted on Mon, Jun. 27, 2011

LAURAN NEERGAARD
The Associated Press

WASHINGTON - Check into the hospital and you may get a blood transfusion you didn't really need.
There's a lot of variation around the country in how quick doctors are to order up a few pints , not in cases of trauma or hemorrhage where infusing blood fast can be life-saving, but for a range of other reasons.

Anemia is common in older patients, for example, who may get a transfusion as an easy boost even when the anemia's too mild to matter or instead of treating the underlying problem. Need open-heart surgery or another complex operation? There are steps surgeons could take to minimize blood loss instead of trying to replace it later.

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

All the variability shows "there is both excessive and inappropriate use of blood transfusions in the U.S.," advisers to Health and Human Services Secretary Kathleen Sebelius concluded earlier this month. "Improvements in rational use of blood have lagged."

Blood banks welcome the idea, important as they try to balance how to keep just enough blood on the shelves without it going bad or running short.

"Better patient care is what's being advocated here," says Dr. Richard Benjamin, chief medical officer of the American Red Cross. "If a transfusion is not necessary, all you can do is harm."

The U.S. uses a lot of blood, 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. In many years, parts of the country experienced spot shortages as blood banks struggled to bring in enough donors to keep up.

Surprisingly, blood use dropped a bit with the recession, roughly 6 percent over two years, Benjamin says. He couldn't say why. That dip has leveled off, but specialists say demand is sure to rise again in coming years as the population rapidly grays and people who once were prime donors become more ill and frail.

Right now, overall donation levels are good with one exception, Benjamin says: There's a big need for more 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.

What's the evidence for avoidable transfusions?

One study published last fall tracked more than 100,000 people who underwent open-heart surgery, a transfusion-heavy operation. Just 8 percent of those patients received transfusions at some hospitals, while a startling 93 percent did at other hospitals. But survival wasn't significantly different at hospitals that used more blood than at hospitals that used less....

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