Blood Transfusions Still Overused

Blood transfusions costly and risky for patients

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Patients are still receiving blood transfusions more often than needed, and a new study suggests premature or unnecessary transfusions could be leading to worse outcomes.

The topic of blood transfusion and when to provide them has been tricky since there are no clear guidelines. Cases of trauma or hemorrhage when they can be lifesaving are exceptions.

"Discuss transfusion protocols with your doctor before surgery."

Steven M. Frank, MD, leader of the study and an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, said that research over the last five years has supported giving less blood, but clinicians have not caught up.

He said that blood conservation is one of few areas in medicine where outcomes can be improved and risks reduced while saving money.

Nothing has indicated it is better to give patients more blood than they need, Dr. Frank said, noting that transfusions are not as safe as most people think.

During the study researchers examined electronic anesthesia records of more than 48,000 surgical patients at The Johns Hopkins Hospital between February 2010 and August 2011. Of those patients, 2,981, or about 6 percent, received blood transfusions during surgery.

They found wide variations between how quickly surgeons and anesthesiologists ordered blood transfusions.

Investigators noticed that heart surgery patients received transfusions at much lower trigger points than those receiving other operations. In comparison patients undergoing surgery for pancreatic cancer, orthopedic problems and aortic aneurysms received blood at higher trigger points, often at or above 10 grams per deciliter.

Guidelines are vague, but generally suggest patients could benefit from a transfusion when their hemoglobin levels dip below six or seven grams per deciliter, and that they do not need blood if the levels are above 10.

Researchers also found that the amount of blood transfused did not clearly correlate with how sick patients were or how much blood is typically lost during certain types of surgeries.

Blood is costly. Dr. Frank noted it costs $278 for each unit of blood purchased from the American Red Cross, while  it costs the organization about $1,100 to acquire, test, store and transport that blood. Medicare only pays $180 for that same unit of blood.

In addition, patients often develop antibodies to transfused blood cells, making a future match more difficult. They also can suppress the immune system, Dr. Frank said, increasing the risk of infections such as pneumonia and sepsis.

Dr. Frank said an exact algorithm that dictates when blood should be transfused would be impossible because each individual surgery is different.

However, he said striving to use less blood when possible would be better for patients.

The study was recently published in journal Anesthesiology.

Reviewed by: 
Review Date: 
April 30, 2012
Last Updated:
April 30, 2012