Red blood cells (RBCs) may well be the Rodney Dangerfield of pharmaceuticals because they seem to get no respect. In fact, two major thrusts in transfusion medicine, patient blood management, and hemovigilance, tend to accentuate negative aspects of transfusion care with inherent messages that blood is very risky and needs to be either avoided altogether or, if given, closely scrutinized. Seldom is heard the encouraging insiders’ word that RBCs are a miracle drug, which in various situations can save your life, provide you comfort, give you energy, sharpen your thinking, and even improve your appearance. Unfortunately, given the current cost-saving pressures in healthcare, such undervaluation may be causing episodes of under-transfusion that adversely affect quality of life for patients and their caregivers.
At the Patient-Centric Transfusion meeting held last week in New Orleans, the assembled blood bankers discussed reshaping perceptions of blood products by exploring the ways in which patients experience their treatments. Reimagined therapeutic endpoints might enable meaningful quantifications, illustrating the value of transfusion, that go beyond 30-day mortality and length-of-stay metrics.
New measures on which to evaluate restrictive vs. liberal transfusion practices could include: 1) days until a patient returns to work; 2) number of well defined “good days” experienced during chemotherapy; 3) days until a patient has the energy to resume accustomed physical and sexual activities; and 4) post-partum activity (pedometer) measures and depression rates. Because the economic pressure not to transfuse has grown dramatically, so must our understanding of why we should transfuse. Â
Fortunately, patients are powerful stakeholders that we can engage in this honest reassessment. Disclosing the fast-acting and dramatic benefits of a dose of RBCs would allow potential recipients to make better informed care decisions. The following testimonial from one of our own blood center employees is instructive:
“As a medical laboratory scientist … until two weeks ago I [had] never had the experience of actually being the patient to receive blood. … I had not even understood how badly I had been feeling, until I started to feel “good” again. One unit down, I suddenly wished I had bothered to go to the doctors sooner. After the second unit (hours later), I felt incredible.”
If professionals who routinely perform cross-matches do not fully appreciate RBC effects, imagine how difficult these connections must be for laypeople to grasp. Perhaps it would be educational if we, like our for-profit, big pharma cousins, launched more descriptive branding for blood products. Fatigue-busting qualities could be conveyed by trade names like “Erythrogizer,” “Cytovigor,” and “Dynofuse.” If this seems farfetched, it says much about the narrow self-conceptions we harbor about our function in dispensing our miracle drugs.[Editor’s Note: Continue monitoring the ABC Newsletter for updates on this initiative.]
John Armitage, MD, CEO; Oklahoma Blood Institute;Â john.armitage@obi.org