Blood Management - Necessity

Necessity

There are multiple issues associated with blood and its transfusion. Considered for decades as a gift of life, blood transfusion is emerging as a treatment with limited efficacy and substantial risks, further under pressure from staggering associated costs and limited supplies. Evidence indicates that a great number of the patients who are being transfused today may not be seeing many tangible benefits from it, as the transfused blood fails to achieve its primary goals – prevention of ischemia and improving the clinical outcomes. Challenge lies in identifying those patients who are at risk of complications of severe anemia (ischemia) and transfusing them, without exposing other patients to unwarranted risks of inappropriate transfusions. Better transfusion practice should not be viewed as an option, but a necessity to ensure clinicians are doing good and not doing harm to their patients.

Cost Issues

Another significant reason to embrace the concept of patient blood management is cost. Allogeneic blood transfusion is extremely expensive. For example, some studies reported increased costs of $300–$1,000 per unit of allogeneic blood transfused. The more blood that is transfused directly impacts hospital expenditures, and of course, it behooves administrators to search for ways to reduce this cost. This increasing cost of transfusions is the reason many hospital administrators are endeavoring to establish blood management programs.

Patient Outcomes

Perhpaps the single most important reason for implementing patient blood management is need to improve patient outcomes. Better outcomes are achieved with the reduction or avoidance of exposure to allogeneic blood. Numerous clinical studies have shown that allogeneic blood transfusions are associated with increased mortality and an increased level of serious complications, while potentially exposing the patient to viral, bacterial, or parasitic agents. Also, current medical literature shows allogeneic transfusions to be beneficial in only a very narrow and specific set of conditions and harmful or at the very least not helpful in the vast majority of times it is actually used. In the absence of clear benefit, the patient is exposed only to risk. An excellent review of the impact on patient outcomes has been written by Aryeh Shander, MD, and can be found in the journal, Seminars in Hematology.