Blood Management Year in Review: Part I

This is Part I of a blog based upon my Blood Management University® year-end webinar by the same title, where I tried to hit the high points of the transfusion medicine literature.  Having been involved in implementing and continuously improving blood management programs for the past 20 years, I find it both gratifying and challenging to try and sort out the most pertinent articles since there has been an explosion of publications in this area. Continue reading

Premedication for Prevention of Transfusion Reactions: A Practice Without Evidence

Premedication-TransfusionFebrile non-hemolytic (FNHTR) and allergic transfusion (ATR) reactions have historically been reported to occur in up to 30% of transfusions, however with the use of leukoreduction and single-donor apheresis platelet products these now occur in 2-3% of patients.1-2 This might be slightly higher in those patients that are transfusion dependent. Although these reactions, if indeed isolated, tend to be mild in their symptomatology, they may also be harbingers of more serious transfusion-associated adverse events. These reactions also cause concern for patients, most of whom have critical diseases necessitating concomitant complex therapies. Continue reading

Stewardship: Waste Not, Want Not

STEWARDSHIP-GRAHPIC-RED

A publication in the upcoming Transfusion journal reports on a successful and practical initiative to reduce blood component wastage via a targeted team approach surrounding blood transport and storage. 1

The national wastage rate for blood products within the United States may be as high as 6% with up to 70% of wastage occurring within our operating suites.2 Most of this is due to improper transport and storage. Continue reading

Transfusion in sepsis: the controversy continues

sepsis-bullseyeRed blood cell (RBC) transfusion in septic patients remains a controversial topic. The well-known and often quoted article by Rivers et al. in New England Journal of Medicine, 2001, was one of the first to attempt to define a protocol for transfusion along with primary use of fluid resuscitation, vasopressors and inotropic agents.¹ The assumption and hope of incorporating RBC transfusion into what was deemed “Early Goal-Directed Therapy” (EGDT) was that anemic septic patients would acquire an increased O₂ delivery during this critical timeframe. Continue reading

Ringing the “T.A.C.O.” Bell

TACO-graphicHats off and ring the bell for Dr. Alam et al. for their upcoming article “The prevention of transfusion-associated circulatory overload” in Transfusion Medicine Reviews, anticipated in print April, 2013!  This review is outstanding as it guides us through the literature, both past and present, surrounding TACO, its definition, estimated incidence, identifiable risks factors, diagnosis, treatment options, and most importantly preventive strategies. Continue reading

The Importance of Physician Opinion Leaders in Blood Management Programs

March is a great time to talk about physician opinion leaders because March 30th is National Doctors Day. Physicians are clearly a key stakeholder group for appropriate blood use, so their engagement and ownership is essential for the success of comprehensive blood management programs. One of the common concerns I hear from hospital administrators and lab staff seeking to start blood management programs is the lack of active physician participation on their transfusion committees and on their blood management team. While the eventual goal is to have all physicians who order blood products fully bought in, an efficient and effective way to begin the change effort is to target key physician opinion leaders. Continue reading

Is it Time for Goal Directed Management of Gastrointestinal Bleeding?

Gastrointestinal bleeding accounts for more than 450,000 hospitalizations annually in the United States and is a major consumer of blood products.1 Blood transfusions are given to 21- 43% of these patients, and acute upper gastrointestinal bleeding has a mortality rate of 10- 14%.2,3 In our large database, GI bleeding consistently ranks in the top 5 list of patient groups receiving blood products, along with cardiac surgery, orthopedics, oncology, and critical care/ trauma.  In a number of hospitals, GI bleeding is actually the #1 consumer of blood products, which often comes as a surprise to hospital leadership.  For reasons discussed below, this is a high risk/ high volume patient population that needs to have a more proactive and evidence-based approach. Continue reading

The Storage Lesion: The saga continues!

Early this year I discussed the potential implications of the “storage lesion” for RBC transfusions in a previous blog post, The Storage Lesion, Soldier On and Stay Tuned. Several studies were cited and questions put forth that remained with the conclusion to soldier on and stay tuned. Recently there have been publications that provide additional information, which continue to fuel the fire surrounding the controversy of “fresh” vs. “old” blood.  Let’s revisit these original questions and see where the literature is today.

Continue reading

The Heartbreak of Blood Transfusions – Part II

I have always emphasized the need for multidisciplinary, representative blood utilization committees as part of a comprehensive blood management program.  To that end, it is important to have representation from the “bloody specialties”, including cardiac surgery, orthopedic surgery, anesthesiology, critical care, hospitalists, and hematology-oncology.  Based upon recent trends in the transfusion literature, it has become evident that also involving cardiologists in blood utilization committees as well as blood management teams is essential. Continue reading