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New randomized controlled trial: Study Finds That Less Blood or No Blood Transfusions Best for Critically Ill Patients
According to Ottawa, Ontario, critical care physician and epidemiologist, Dr. Paul Hébert, "It's the first study that evaluates how we transfuse ...We have really good data on what the (blood) product is like. It's well screened, it's extremely safe and it's life-saving. No question about that, (But) after 50 years of transfusions, we've never done any studies. This is the first...and what we've found is we can get away with less."

And what was the result of the study? The study involved 838 critically ill patients, including those suffering from organ failure and injuries from car accidents, who were admitted to intensive care units at 25 Canadian hospitals.

Traditionally, blood transfusions have been liberally administered to critically ill patients in the belief that maintaining high hemoglobin levels (high levels of oxygen-carrying red blood cells) would improve survival. In this multicenter, randomized controlled clinical trial, , patients were randomized into either of two transfusion groups: one group received transfusions when they were even slightly anemic, as measured by their hemoglobin levels and the other were administered transfusions only when they were severely anemic.

Hébert and the investigators concluded that the group that were liberally transfused had a higher mortality rate after 30 days -- 23% compared with 18% for the patients given less blood. There was a bigger difference in the percentage of younger and less sick patients who died. Among the patients under 55 years of age, only 5.7 percent of those in the restrictive transfusion/no-transfusion group died within 30 days, compared with 13 percent of those in the liberal transfusion group. Among those who were less critically ill, the figures were 8.7 percent and 16.1 percent. The patients who had fewer transfusions also suffered less organ failure.

"This is for free and it saves lives. This is a major, major effect and a major move forward," Hébert said. "In a day where there's a daily shortage of blood across the city, this will help."

An editorial in the February 11, 1999 issue of the New England Journal of Medicine makes this comment about the report:

"Subgroup analyses showed that among patients who were less severely ill (Acute Physiology and Chronic Health Evaluation II score, less than or equal to 20) and among those who were less than 55 years old, the patients assigned to the restrictive strategy of transfusion were half as likely to die within 30 days as those assigned to the liberal strategy….The higher in-hospital mortality rate associated with liberal transfusion practices is striking. From the data presented by Hébert et al. we calculated that among the patients who were less than 55 years old, one more death occurred for every 14 patients treated with the liberal strategy. Similarly, among the less severely ill patients, one additional death occurred for every 13 patients treated with the liberal strategy. Moreover, the restrictive strategy resulted in a relative decrease of 54 percent in the number of transfusions, and 33 percent of the patients assigned to this strategy did not receive any red-cell transfusions. If the restrictive-transfusion strategy was widely adopted, the resulting cost savings and conservation of blood would be laudable achievements".

``This is a landmark study. This is big-time,'' said Dr. Stephen Cohn, chief of trauma and surgical critical care at Jackson Memorial Hospital-University of Miami School of Medicine. He said it will have a far-reaching effect on the treatment of the critically ill. Cohn and Dr. Robert Taylor, president of the Society for Critical Care Medicine, said they plan to use Hebert's guidelines in their hospitals. Taylor emphasized the findings don't apply to patients who are bleeding or suffering from heart attacks, cardiovascular disease or emphysema. Nobody knows just how many patients the nation's ICUs treat a year, or how many transfusions they get. But Cohn said one 20-bed intensive care unit at Jackson Memorial gave patients about 125 units of red cells a month in 1997. Hebert's findings would let the ICU eliminate at least one-third of those, Cohn said. At a conservative $200 per transfusion, that could mean $100,000 a year in savings in that ICU alone.

The consensus is that less blood or no blood is better for patients and for the hospital's bottom line. [ Top of page ]
For more information about how your facility can benefit from non-blood management of medical and clinical cases contact BMSI.

An Answer to the Blood Supply Crisis

 
Nation's blood supply failing to meet demand - Fears emerge that new restrictions on blood donors will add to a year of national shortages.             American Medical News Aug. 20, 2001

World facing serious shortage of safe blood - The world is facing a severe shortage of blood for transfusions.   The News International Thursday April 08, 2004--

(Pennsylvania/New Jersey) Area's Blood Supply Reaches Emergency Levels; American Red Cross Needs Blood Donors Today.  American Red Cross, Penn-Jersey Region  Monday June 28, 2004

NEW YORK BLOOD CENTER FEARS - WORST BLOOD SHORTAGE EVER THIS SUMMER --Some Blood Types Already Being Rationed     NEW YORK, NY, JUNE 21, 2004

 Eastern Kentucky Facing Blood Supply Shortage - The blood supply regionally has dropped to critical levels, forcing the American Red Cross to cut back on hospital orders, officials said. WKYT online June 30, 2004

Eighty-two percent of the world's population does not have access to a regular and safe supply of blood, the World Health Organization (WHO) said Thursday, ahead of World Blood Donor Day next week.  GENEVA, June 10 (Xinhuanet)

“…the majority of the American Red Cross Blood Services regions operating with less than one day's supply of blood, the potential for catastrophe is slowly climbing.”  DisasterRelief.org 2004

Blood banks have asked hospitals in Atlanta, Baltimore and Washington, D.C. to postpone elective surgery, Ensinger said. New York, Chicago, Detroit, Cincinnati and parts of Oregon were considering similar requests. 01/08/99 - Associated Press

Blood banks were begging for donors Monday and hospitals have postponed elective surgery after more than two weeks of harsh winter weather worsened the nation's usual post-holiday blood shortage. 01/05/99 - Associated Press

The Los Angeles area blood shortage is getting more acute by the day, forcing one hospital to delay transfusions Tuesday, another to nearly cancel two. 01/14/98 Washington Post

Serious Blood Shortage Threatens Local Hospitals - Puget Sound...SEATTLE, June 22 The region's blood supply is not keeping pace with demand. 06/22/98 - Seattle Times

Winter'98 blood shortages - worsening by the day. More blood centers issuing public appeals for blood donors now than at the beginning of the week. American Blood Centers Press Release.

The American Blood Center reports, "Blood centers often run short of type O and B blood. Shortages of all types of blood occur during the summer and winter holidays. Red blood cells can be stored for up to 42 days. Platelets can be stored for only five days." “Shortages are worsening because demand is growing and the donor base is shrinking. Demand continues to increase because of the aging of the patient population and increased use of blood intensive procedures such as solid organ transplants, hematopoietic progenitor cell transplants, aggressive chemotherapy, etc…. We must now resort to emergency blood appeals during times of the year that used to be periods of abundance. In the opinion of ABC members, the fragility of the blood supply is a public health issue that must be addressed, and measures that affect the available donor base must be managed carefully to prevent shortages that injure patients…. we must recognize that available data suggests that the U.S. blood supply is on the verge of a crisis.”

"Many of us believe we're on the brink of a crisis," said Harvey Klein, MD, president of the American Assn. of Blood Banks.

"For the first time in memory, we've had a year of national shortages, not just regional shortages and not just shortages at what are generally considered to be the time periods when blood is always in short supply," he said.

When shortages strike, banking officials must scramble to fill the demand. Sometimes hospitals are asked to restrict or postpone surgical cases. The American Blood Center observes, "Every three seconds someone needs blood. Blood and blood products are used to treat accident and burn victims..." If blood supplies are depleted for elective cases what happens to accident victims who need blood to survive? A blood bank manager in Tacoma, WA comments, "Some days reserves are so low that one major traffic accident would totally drain our stores".

Hospitals Address the Shortage
In many communities help is coming from an unusual source – the main users of blood, Surgery Centers!  All over the country a growing number of hospitals are taking steps to drastically lower and in many cases eliminate blood use as they develop Transfusion Free or Bloodless Medicine and Surgery Programs. These programs deliver virtually every traditional medical service without blood transfusions.  Jan Graziani, Director of the Bloodless Medicine and Surgery at Chicago's Swedish Covenant Hospital say's, "Our patients wouldn't be well served if all we did was tell them we would let them die rather than give them blood. We don't just take blood out of the treatment arsenal. We provide life saving alternatives to blood transfusions".  Sharon Vernon, Director of Education for Hemo Concepts and the Bloodless Medicine and Surgery Institute (BMSI) observed, "Bloodless or Blood Conservation Programs not only decreased blood utilization hospital wide, but as a result also lowers the strain on the entire community blood supply".

While traditional treatment centers consider low blood supplies a dire emergency, Bloodless Medicine and Surgery Programs consider it just another day in surgery. While the blood banks are scrambling for donations, hospitals are doing their part by working to lower the amount of blood used. More and more hospitals are taking advantage of bloodless or transfusion-free medicine and surgery programs to accomplish this.  

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For more information about Bloodless Medicine and Surgery you can contact BMSI.

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Copyright© 1998-2006 by: Bloodless Medicine & Surgery Institute. All rights reserved. Updated 11/24/06