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In Transfusion, More Blood Means More Risk, Higher Cost

Cheryl Clark, for HealthLeaders Media, April 30, 2012

Many surgeons put their patients in harm's way by transfusing far more blood than necessary for good outcomes, and incurring enormous and avoidable expenses for their hospitals and for society—as much as $1,100 per unit.

That's according to a study of highly variable use of blood and components by surgeons who operated on nearly 3,000 patients at Johns Hopkins Hospital between February, 2010 and August, 2011. The research paper was published in the April issue of the journal Anesthesiology.

Current research says transfusions for most surgeries should not be initiated until the patient's hemoglobin level—normally 12 to 14—has dropped to 6 or 7 grams per deciliter (g/dl).  A level of 7 or 8 is considered safe.

But the recommendations of three specialty societies that guide current practice leave the trigger point in question. "They say that if a patient's hemoglobin level is less than 7 g/dl, then the patient would benefit from a blood transfusion. But if it's greater than 10, they would not benefit. But they don't say what should be done if the level is between 7 and 10," Steven M. Frank, MD, leader of the study, said during an interview.

Thus, many surgeons initiate transfusion when levels are at 10, while others start at 9 or 10 or 11.  Additionally, surgeons vary in the target point at which they stop transfusing. Some stopping at 11 or 12, even though they could stop at 10.

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