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Blood Use, Quality, and Cost

Cheryl Clark, for HealthLeaders Media, March 13, 2013
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Demand is increasing because there are more uses for blood products. And as more people receive insurance coverage starting next year, more will be eligible for procedures, such as hip and knee replacements, that use more blood.

James AuBuchon, MD, CEO of the Puget Sound Blood Center and an AABB past president, points out that "most physicians have had incredibly poor, insufficient training in transfusion medicine." That's because until relatively recently there's been a lack of evidence-based safe protocols in blood transfusion. The AABB published its Red Blood Cell Transfusion: A Clinical Practice Guideline in the March 2012 issue of the Annals of Internal Medicine, recommending a "restrictive transfusion strategy" of 7-8 g/dl in stable patients.

A lurking, highly controversial issue in recent publications suggests that transfused patients mysteriously have poorer outcomes than similar groups of patients who don't get blood. There may be something else going on when blood from one person courses through another person's body.

"That's been a very difficult subject to wrestle across the goal line of truth, because patients who need transfusions are usually sicker," AuBuchon says. "Whether transfusion is causing a poorer outcome is unknown. But there is certainly concern that maybe there is a causal link." It may be, he adds, that older units of blood cause poorer outcomes than fresher ones. Federally funded studies are under way.

Across the country, some hospitals are showing how it can be done.

At 700-bed Texas Health Harris Methodist Hospital in Fort Worth, Laboratory Medical Director Patricia Fenderson, MD, PhD, says the hospital has saved increasing amounts every year since 2007, when she realized doctors were often transfusing patients at hemoglobin levels of 9 g/dl or higher. Now she's gotten doctors to hold back.

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