Loyola limits blood transfusions to reduce risk to patients, trim costs

Each year, more than 5 million people in the United States receive blood transfusions.

Though transfusions can be life-saving, the medical use of blood products comes with a certain amount of risk to patients from allergic reactions, overuse, infections such as HIV and hepatitis and from other complications.

Loyola University Hospital is among a handful of medical centres in the U.S. that has put initiatives in place to track and better understand those risks, along with instituting stricter measures to cut down on the number of transfusions given to patients.

'It's really a patient safety issue,' said Dr Steven Edelstein, professor, department of anaesthesiology, Loyola University Chicago Stritch School of Medicine, Maywood, Ill. 'At Loyola, we want to be certain that in every instance in which a transfusion of blood or blood products is considered that we balance the risk and benefit for patients.'

Annually, more than 50,000 transfusions of blood and blood components take place at Loyola. Trauma victims, organ transplant patients and patients undergoing therapies for cancer are all dependent on transfusions. Transfusions are also vital for those with sickle cell anaemia, some premature births and patients undergoing heart or joint replacement surgery.

Though the blood supply is the safest in history, a transfusion is in effect an organ transplant, Edelstein said. Each transfusion brings with it changes in the immune system that can lead to higher rates of infection and other complications.

'For example, it is possible that patients who have cancer and who receive a blood transfusion may be at a higher risk of recurrence. Why it occurs may be related to the immune effects of the transfusion, but it is unclear,' Edelstein said.

The unit cost of blood has risen dramatically over the past decade, due chiefly to new testing of blood for infectious diseases, which also affects the bottom line at hospitals nationwide as well as at Loyola.

About a year and a half ago, Loyola's Blood Usage Committee began a Blood Management Program to study and find ways to control those costs and limit patient risks

'We're way ahead of the curve,' said Edelstein, who chairs the committee. 'We're being very proactive.'

The committee organised a multidisciplinary blood management workshop to get input from nursing, anaesthesiology, surgery, stem-cell transplantation, haematology/oncology, risk management and hospital administration. With this information in hand, the hospital developed a blood management audits and implementation plans that spells out the changes that needed to take place.

The changes are already having a positive effect. To lower the risk of anaemia, intensive care nurses at Loyola are cutting down on the number of daily blood draws from patients. The hospital has also invested in blood cell salvage technologies that allow for the recycling of a patient's blood during an operation. In addition, Loyola uses drugs that can cut down on the need for transfusion and is in the process of instituting a transfusion-free surgery program under the direction of Dr Hieu Ton-That, Department of Surgery - Trauma Division.

'The key is educating people to recognise the complications for transfusing of any blood product and how to do a better job of managing all blood therapies,' Edelstein said.