Appropriate transfusion is good for patients. Blood transfusion saves lives every day. However, benefits of transfusion are not included among the data collected by patient blood management (PBM) and hemovigilance programs. We need to develop indicators and count successes of transfusions therapy.
In the early days, blood was scarce because of limited storage and preservation technologies. Blood bankers were the only professionals recommending sparing use of blood products, while physicians encouraged transfusions that made their patients get better and feel better.
AIDS shattered our view of transfusion safety, prompted randomized trials that provided evidence supporting a conservative approach to blood use and the birth of hemovigilance in France and Serious Hazards of Transfusion (SHOT) in the UK, programs that quantified recognizable risks. Together with AABB, the Centers for Disease Control and Prevention developed the National Healthcare Safety Network Hemovigilance Module to collect data on transfusion-associated adverse events.
Observational studies and clinical trials continue to examine adverse outcomes. In the US, fear spurred “bloodless medicine,” previously reserved for patients who rejected transfusions because of religious convictions. Professional societies have prepared restrictive guidelines for transfusion of blood components. Informed consent forms for patients emphasize potential risks and barely address potential benefits; a survey at the University of Alabama at Birmingham reviewed on the front page of today’sNewsletterconcludes that “a sizable percentage of patients still perceive transfusion as having significant associated risk.”
Obviously, lower use means lower costs for hospitals and lower costs encourage adoption of blood utilization measures. Hospital administrators, healthcare economists, and consultants are happy since PBM is a physician-supported activity. Unfortunately, they are counting only adverse events, not lives saved or improved outcomes. The only outcomes reported by adverse event databases are suboptimal ones and the foregone conclusion that blood is bad. The only conclusion that can be extracted from Food and Drug Administration reports on transfusion-associated fatalities is that “blood still kills.”
Tragically, adverse events based observational and clinical trial data encourage restrictive transfusion policies, and the popular yardstick for success of PBM for transfusing physicians and administrators is a reduction in the number of transfused products (the low hanging fruit), not data on transfusion-associated benefits for patients, which are difficult to collect. It is sad that many of the recommendations for use of blood as a therapeutic resource and some PBM guidelines focus on what SHOULD NOT be done, rather than what SHOULD be done. Appropriate transfusion is good for patients! We urgently need to identify, develop, and incorporate true measures of transfusion success in PBM and hemovigilance programs to provide a balanced view of transfusion medicine.Â
Celso Bianco, MD, Honary Member;Â celso@txmedicine.com