Once considered the standard of care for hospital patients showing even the slightest signs of anemia, blood transfusions might soon become a treatment of last resort.
The widely used procedure's fall from grace has been triggered by mounting evidence transfusions can pose serious risks to patients and often are medically unnecessary.
A growing number of hospitals, including health care leaders Johns Hopkins, Cleveland Clinic and Duke University Medical Center, have started blood conservation programs aimed at limiting transfusions to only life-threatening cases.
"It's now clear transfusing patients does not necessarily result in better outcomes," said Dr. Brad Collins of Charleston Pathology, a proponent of stricter blood management. "A transfusion is like a transplant. You're introducing a foreign substance from another human being into a person's body. The natural reaction is for the body to reject it."
Blood transfusions are fairly routine treatments for trauma victims, as well as cancer, surgical and other hospital patients. More than 30 million blood products are transfused in the United States each year. But it was only this spring that a handful of the nation's medical centers and federal agencies began a pilot program to track dangerous reactions to blood transfusions.
Collins, who serves as Beaufort Memorial Hospital's Medical Director of Laboratories, collaborated with hospital administrators to get BMH on the forefront of the blood conservation movement. In May 2008, the hospital initiated its own program, making it the first health care provider in the region to offer a set of comprehensive strategies and tools that can be used as alternatives to donor blood transfusions. So far, the program has reduced blood usage at the hospital by 16 percent.
"It's not about counting the number of bags we're transfusing," Collins said. "Our No. 1 goal is to improve patient outcomes and provide better care."
While technological advances in blood testing have virtually eliminated the risk of transmitting HIV or hepatitis, tests have not yet been developed for some infectious diseases and viruses. Emerging pathogens also are a threat to the blood supply.
And then there is the risk of human error. The leading cause of death from transfusions is the administration of incompatible blood. It is estimated a unit of blood passes through as many as 17 different hands between the time it is donated and it is administered to a patient.
Beaufort's Blood Conservation Program offers patients alternative treatments to transfusion, including iron supplements and synthetic hormone injections that stimulate the patient's own red blood cell production, vitamin C to enhance iron absorption and vitamin B12 shots and folic acid to help with red blood cell formation.
"The idea is to boost the system," said Beaufort Memorial Hospital Blood Conservation Program Coordinator Terry Libby, a registered nurse who received intense specialized training in blood conservation at the Bloodless Medicine and Surgery Institute at Cleveland Clinic in Ohio. "Your body virtually becomes its own blood bank. If we can help our patients rejuvenate their own blood, we may not have to give them a transfusion and put them at risk."
In the operating room, BMH physicians are using a variety of blood-saving tools and techniques, among them laparoscopic and/or robotic surgery, special scalpels that lessen blood loss and a "cell saver" device used to collect and recycle a patient's blood during surgery.
"We use whatever is appropriate for the patient based on their medical condition," Libby said. "When combined, these treatments and tools can have a huge effect."
Another strategy is called "micro-sampling," in which tiny blood samples are taken for lab testing rather than the standard size tubes.
"This is especially important with our critical care patients who have extended hospital stays," Libby said. "These patients can easily lose an average of one to two units of blood during their hospitalization using standard tubes. This technique can save a great deal of the patient's own blood."
In addition to improving patient outcomes and reducing the cost of care, a more conservative approach to blood transfusions saves blood for patients who truly need it.
"There is a place for transfusions," Collins said. "When a person is actively bleeding, it is the only thing that can save their life. But we need to find every opportunity to treat patients with their own blood whenever possible."
For more information on Beaufort Memorial Hospital's Blood Conservation Program, call Libby at 843-522-5293 or go to www.bmhsc.org.
To donate blood, call The Blood Alliance at 866-500-4749 or go to www.thebloodalliance.com.