By Ahmar U. Zaidi, MD
The first transfusions in the 19th century were rife with adverse events, poor outcomes, and even patient deaths. To no one’s surprise then, medical providers became dubious of this “dangerous” procedure. It was after Landsteiner and Jansky independently identified the major blood groups that transfusions started on a path to safety.
There is no doubt that in 2019, we are entirely contented with our preparation, storage, and delivery of blood. Perhaps it is this very comfort, the luxury of having access to clean, matched, fresh blood, that has cemented red blood cell (RBC) trans- fusion as the most frequent and overused procedure in North America. Despite the best efforts of major institutions such as ASH and ABIM to control the overuse of this intervention, we are well below the mark. This issue festers and is deeply rooted in multiple subdisciplines within hematology. For this reason the session titled Transfusion Medicine: Optimizing Patient Blood Management (taking place Monday at 7:00 a.m., and again at 4:30 p.m.), examining the optimization of blood transfusions using patient blood management (PBM), is a can’t-miss.
PBM describes the proactive multidisciplinary and collaborative strategies for delivering patient health care with a goal of improved outcomes. It is an undertaking that needs the involvement of multiple health care providers (physicians, nurses, pharmacists, pump techs, and other physician extenders) to provide patient management in numerous clinical scenarios, without transfusion. This session will bring attention to strategies that allow us to avoid RBC transfusions.
The avoidance of RBC transfusions requires, at its core, a proactive methodology. Yulia Lin, MD, of University of Toronto, will discuss innovative methods to manage preoperative anemia, known to result in postoperative morbidity and mortality, through the establishment of preoperative anemia-screening clinics. Dr. Lin said, “the most common cause of preoperative anemia is iron deficiency, which is easily corrected; so why subject a patient to increased postoperative risk if this anemia is easily correctable?” And this is certainly a common problem, Dr. Lin continued, noting that 25 to 40 percent of patients have preoperative anemia. She will discuss the goals of management of preoperative anemia, which are to treat anemia, reduce the need for transfusion, and improve patient outcomes.
In the next presentation, Michael Murphy, MD, FRCP, FRCPath, of the University of Oxford and the current president of the American Association of Blood Banks will discuss practice and research recommendations for PBM interventions, including the need for better evidence, improved patient outcomes, and lower hospital costs. He will emphasize the importance of integrating these practices into day-to-day care. Finally, Lawrence Tim Goodnough, MD, of Stanford University will review his institutional experience with the use of clinical decision support integrated into the electronic medical record to promote reductions in RBC transfusion practices.
We live in an era of established safety in transfusions of RBCs, but the nuances associated with blood overuse and transfusion-related morbidity and mortality necessitate the engagement of the hematology community to revise its approach to blood transfusion. This Monday session, chaired by Dr. Goodnough, will arm hematologists with a map of how to establish these practices at their institutions, to drive forward patient outcomes, one withheld transfusion at a time.
Dr. Zaidi indicated no relevant conflicts of interest.