Lawrence Goodnough, Series coordinator and Director of the Transfusion Service and Professor of Pathology and Medicine at Stanford University Medical Center in the USA, said that "the presumed benefits of blood transfusion are being challenged by the findings of recent trials which show that restrictive transfusion practices are equivalent or better than liberal practices, even for patients with heart disease and the elderly."
Translating these findings into clinical practice and targeting the right staff group is currently a top priority.
A blood transfusion is when blood is administered intravenously straight to the blood vessels. Every year approximately 24 million blood products are transfused in the U.S.
NHS haematologist describes the process of giving blood
There isn't much medical guidance on when/whether to give surgical patients blood transfusions. The use of hemoglobin levels to assess whether a transfusion is necessary is a subject of much scientific scrutiny and may explain why there is so much variation in practice.
The American Association of Blood Banks recommends that doctors only consider transfusing at a hemoglobin threshold of 7 to 8 g/dL, as the evidence shows no difference in mortality.
In addition there isn't much evidence on good blood transfusion practice, considering there are only a limited number of high-quality trials to use as a basis.
A previous study that analyzed 25,000 Medicare patients, revealed that blood transfusions among hospitalized cardiac patients can potentially double their risk of infection and increase their risk of death by a factor of four.
In addition, at the 2010 American Society of Anesthesiologists Annual Meeting, researchers explained that massive blood transfusion is associated with a significant increase in perioperative risk for mortality, cardiopulmonary complications, and wound-related and infectious complications in the long term.
Doctors in the U.S. and U.K. are transitioning to a more restrictive approach when it comes to transfusing red blood cell units, with a 3% drop in both 2009 and 2010 in the U.S and 3% in 2012 in the U.K.
Efforts in the U.S. to carry out blood transfusions more efficiently have already begun - the adoption of best practice support alerts and electronic order systems at Stanford University Medical Center successfully managed to reduce transfusion rates. Similar practices that involve patient blood management are also being carried out in other countries.
However, there still remains considerable variation between hospitals in the reduction of blood use. Goodnough noted that "national audits of blood components in the UK suggest that overall blood usage could be further reduced without patient safety being compromised."
A previous survey, which included a total of 1,000 different American institutions, revealed that only 14% of anesthetists had an institutional transfusion monitoring group and only a fifth of had been informed of the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists transfusion guidelines.
Goodnough concludes that there is still a lot of work to be done:
"Professional societies are well positioned to incorporate blood transfusion outcomes as quality indicators in their own guidelines and recommendations. Physicians and hospital departments of quality and cost-effectiveness should introduce patient blood management initiatives to improve patient safety and clinical outcomes."
Written by Joseph Nordqvist