Re-thinking blood transfusions

Use blood transfusions sparingly:

Long dominated by Jehovah’s Witnesses — whose faith forbids blood transfusions — bloodless surgeries and blood conservation programs are now attracting mainstream patients worried about what some experts say are clear risks, including more infections, longer recuperation, increased illness and even death.

"The best blood is in your own veins,” said Dr. Lori Heller, medical director of the blood management program at Swedish Medical Center in Seattle. “We want to think before we transfuse.”

Decades of experience with Jehovah’s Witness patients, including 1.5 million members in the United States, has helped propel the new emphasis on blood management, said Sherri Ozawa, clinical director of the Institute for Patient Blood Management at Englewood Hospital and Medical Center in New Jersey.

“In the early days, it was, ‘We have Witness patients, what in the world do we do with them?’” she recalled. “Now we believe it should be the standard of care.”
...
The shift started in about 1999, when first studies in Canada indicated that patients who got transfusions seemed to do worse than those who didn’t. Since then, the awareness has grown, said Dr. Timothy Hannon, a former Navy flight surgeon who founded Strategic Blood Management, an Indianapolis consulting firm hired by hospitals interested in cutting blood use.

“As our knowledge of transfusions has progressed, we find that transfusions are less beneficial than we once thought and more harmful,” Hannon said.
...
The trouble with that, said Marques, whose hospital hired Hannon, is that every blood transfusion is like a miniature organ transplant, with the potential for reactions, errors and infections.

“Anytime we’re exposed to someone else’s blood, we’re exposed to antibodies we’ve never seen before,” she said. “People think blood is lifesaving, but complications are the price you pay.”

Studies have shown that blood transfusions are associated with higher levels of hospital-related infections, pneumonia and central-line sepsis, a blood infection.
...
For consumers haunted by the HIV outbreaks of the 1980s, transmitted infections were a reason to fear blood. Today, however, the estimated risk of a major viral infection from a unit of blood is very low — about 1 in 1 million units of blood, according to a 2008 study in the journal Advanced Studies in Medicine.

By contrast, the risk of complications not related to infection — such the potentially fatal condition known as TRALI, or transfusion-related acute lung injury — is estimated to be about 1 in every 5,000 units of blood component transfused, and possibly more.

In addition, recent studies have shown that storing blood too long reduces its ability to carry oxygen in the body and increases chances of complications.
...
In cases of severe trauma or anemia, transfusions are appropriate, agreed Hannon, a practicing anesthesiologist who orders blood himself.

The trick, he said, is to be judicious. Make sure patients aren’t anemic before they show up for surgery. Build up their blood with iron or erythropoietin, or EPO, a hormone that promotes the formation of red blood cells. Reduce the amounts of blood draws or eliminate some tests entirely.

“If you are in the ICU for five or so days, you’re going to get an extra unit of blood because the vampires have taken so much,” Hannon said. “We have a lot of wastage.”

Like all major medical interventions, blood transfusions are two-edged swords and should be used sparingly and only in emergencies.