Blood transfusions have become commonplace throughout most medical specialties. In fact, every three seconds someone gets a blood transfusion in the United States. According to the American Red Cross, blood can be safely stored for up to 42 days. However, new research indicates that old blood can increase morbidity and length of stay, and has especially adverse effects on the sickest patients. As a result, many physicians and medical organizations have changed their approach to patient blood management (PBM).
Why Newer Is Better
The above mentioned research was compiled just last year by physicians from Johns Hopkins and New York Presbyterian Hospitals. Their conclusions were that red blood cells stored longer than 35 days were associated with increased morbidity when given to the sicker patients. Why does this happen?
The New York Times reported on several trials and studies that help answer that. After just 21 days, the membranes of blood cells stiffen. That loss of flexibility inhibits blood cells from squeezing through the tiny capillaries to deliver life-saving oxygen.
Having this information has already prompted the Red Cross to distribute blood differently. Red Cross CMO Dr. Richard Benjamin told the NY Times that the newest blood goes to facilities that use it infrequently, leaving older blood for trauma centers and academic medical centers.
How to Respond
Researchers realize that transfused blood has never been tested with the “same rigor that goes into testing drugs.” This is changing. Several trials are taking place, including the one mentioned at the outset. In the meantime, medical centers are taking a new look at patient blood management, primarily by finding methods of reducing the number of blood transfusions. The Society for the Advancement of Blood Management has gathered much research pointing to the benefits of avoiding unnecessary blood transfusions, including better patient outcomes and quicker recoveries.
Well-known facilities like Johns Hopkins, Duke University Medical Center, Columbia Medical Center, and Mount Sinai Beth Israel have implemented formal blood management programs to monitor blood usage throughout their organizations. Just last month, MedStar-Georgetown University Hospital in Washington, D.C. received a Patient Blood Management Certification from The Joint Commission and AABB. The Joint Commission stated their evaluation is based on a program that “promotes patient safety and quality through the implementation of practices that can help to reduce unnecessary transfusions, improve patient outcomes and reduce patient’s length of stay and readmissions.”
What are these PBM programs doing to reach these goals? It’s a combination of organization-wide awareness, pharmaceuticals and tools that prevent blood loss during surgery. While these tools are generally available at any medical facility, making their use part of common practice is imperative to a successful PBM program.
Consider just two well-known tools and how they fit into PBM.
- Cell salvage machines ensure that blood lost to the surgeon is not lost to the patient. Patient blood is collected through suction at the surgical site, cleaned in the cell salvage machine and red blood cells are returned to the patient. In addition to being used during surgery, physicians can use cell salvage postoperatively as well by placing a wound drain at the surgery site. Returning the patient’s own blood to them not only saves donor blood for other patients, but it eliminates many risks associated with donor blood for the patient on the table.
- Hemodilution is another simple process that can be utilized to prevent an unnecessary transfusion. Blood is withdrawn from the patient at bedside and mixed with a non-blood fluid expander to maintain volume. When the patient bleeds during surgery, they are losing the diluted blood, minimizing the amount of red blood cells lost. Near the end of surgery, the patient’s whole blood is returned.
While it may be years before enough research is gathered to change blood storage standards, patients and medical centers are benefiting now from PBM programs. Get on board and reduce the chance that your patients will receive old, ineffective blood.
