FORT MYERS, FL — Blood transfusions are among the most common medical procedures at U.S. hospitals, but when it comes to this lifesaving treatment, more is not always better.
Patients receiving too many blood products — blood, plasma, and so on — are more likely to experience medical complications, including infections and organ damage.
A growing number of hospitals hope to reduce these risks by limiting their use.
Lee Memorial Health System is one of them. The largest hospital system between Tampa and Miami, Lee Memorial has already reduced blood-product usage by 2,200 units over the last year, an 11 percent drop.
The health system has saved more than $2.5 million in staffing and supply costs by paring back transfusions over the last year, said Dr. Chuck Krivenko, the health system’s chief patient safety officer.
Krivenko calls them “liquid organ transplants,” a term meant to underscore the serious nature of such procedures.
“What we’ve been focusing on is, what’s the appropriate amount of blood to give, and when and how?” Krivenko said. “Blood is really important: It’s lifesaving. But it should really be used sparingly.”
Hospitals also have a strong financial incentive to cut back. Medicare and many insurance providers will not pay hospitals for transfusion-related errors. And while most of the blood Lee Memorial uses is donated directly to its blood collection division, about a quarter of it is bought from the National Blood Exchange.
Lee Memorial, which operates four hospitals in Fort Myers and a variety of specialty clinics and health centers, performs about 20,000 transfusions a year, according to spokeswoman Mary Briggs.
Krivenko estimates that the health system was using 20 percent to 40 percent too much blood when it started its program to reduce usage last year. He said the health system hopes to reach a 20 percent reduction by the end of next year.
Blood-usage training sessions will be mandatory for many medical staffers next year, Krivenko said. And the health system’s electronic medical records system will also include new prompts to advise staff about the blood conservation recommendations when transfusions are electronically ordered.
Patients themselves are unlikely to notice much change in their treatment, and the new policy does not supersede what doctors determine to be the best course of treatment.
But the blood policy does change some key recommendations. For instance, doctors commonly order two units of blood for transfusions. The new health system policy suggests that one unit may be enough for many patients.
The organization is also recommending a slight reduction in the lowest allowable levels of hemoglobin (oxygen-carrying red blood cells) before a transfusion for otherwise stable patients.
Medical staff is adapting to the changes, Krivenko said.
“It’s something everybody is doing and everybody is understanding,” he said. “It’s becoming the norm.”
Blood transfusions became commonplace in the late 1930s, when storage of donated blood became widely practical.
But studies over the last decade or so have found that blood does not have the therapeutic value doctors once assumed and is far more dangerous, said Dr. Timothy Hannon, founder of the Indianapolis-based Strategic Healthcare Group that is advising Lee Memorial on its blood usage.
Transfusions increase the likelihood of lung injury, a condition that accounts for the majority of transfusion-related deaths, according to the Food and Drug Administration. Other studies show that transfusions may also increase patient infections, because the transfused blood may overwhelm immune systems.
“We now know that blood is not nearly as beneficial as we used to think it was, and substantially more harmful,” Hannon said. “Blood does have value but not as much as we previously thought.”
A 2011 government survey of U.S. health centers found that about 30 percent have some sort of blood-management program.
Graham Sher, president of AABB (formerly the American Association of Blood Banks), said U.S. health care organizations are increasingly implementing their own blood-management plans.
Is there a downside to these reductions? For patients, probably not, said Sher, though hospitals should be careful not to be too blood-stingy for sick patients.
And some blood banks might take significant financial hits, forcing consolidations in the industry, he said.
U.S. demand has likely dropped 10 percent to 15 percent in the last few years, he said.
“I think everyone recognizes this is the right trend,” Sher added.
(Perfusion.com, Inc. provides perfusion and blood management services to Lee Memorial Health Systems)