At Twin Cities hospitals, doing more with less blood

  • Article by: JEREMY OLSON , Star Tribune
  • Updated: October 21, 2013 - 5:55 AM

The sharp decline saves hospitals money and appears to reduce surgery complications.

Twin Cities area hospitals have cut their use of donated blood by thousands of units over the last five years, abandoning long-held but thinly researched criteria about which patients need transfusions after surgery and those who do not.

Allina Health estimates its 12 hospitals have used 14,000 fewer units of blood since January 2010, when it adopted research-based standards that reduced the number of anemic patients who received transfusions after surgery, and the amount of blood given per ­transfusion.

“If you’re bleeding out, blood is going to save your life,” said Dr. Lauren Anthony, a pathologist who led Allina’s efforts to reduce transfusions. “But if you’re not bleeding out, blood is not as beneficial as they used to think it was.”

The change has profound ­consequences for many hospitals, given that each transfusion costs hundreds of dollars and puts patients at risk of ­complications.

But it has occurred mostly out of ­public view. Patients often have little idea that transfusions weren’t provided to them. Hospitals and blood banks have also been delicate about delivering the news, for fear that people might conclude they don’t need to donate any more.

Blood remains a “precious gift” that is lifesaving for patients suffering from cancer, heart problems, ­traumatic injuries and other medical problems, said Dr. Jed Gorlin, medical director of Memorial Blood Centers, a St. Paul-based blood donor agency. “When we ask for it, we need it,” he said. “We don’t ever want to cry wolf.”

But because transfusions are considered “liquid transplants,” they present risks including infections, ­prolonged hospital stays, and hypervolemia — a condition that results when patients have too much blood filling their veins.

As a result, hospitals have used multiple strategies to reduce blood use, particularly in patients ­undergoing cardiac and orthopedic ­surgeries.

The main strategy has been lowering the hemoglobin measurement hospitals use to indicate the need for a transfusion. Hemoglobin gives blood its red color and aids in the transfer of oxygen and carbon dioxide to and from red blood cells. A healthy level in adults is around 13 grams per deciliter.

Transfusions used to be ordered if patients had ­anemia, a blood cell deficiency that causes weakness and fatigue, and hemoglobin readings of 8 to 10. Now, transfusions aren’t considered until readings are as low as 7 — unless patients are ­showing significant symptoms related to their blood loss.

The American Association of Blood Banks made that a formal guideline in 2012.

Body did its job

Tammy Labey, 54, had no idea she was passed over for a transfusion this August until she looked back at medical records from her double knee replacement at Regions ­Hospital in St. Paul and discovered she had been anemic.

The hospital, in partnership with the American Red Cross’ local blood donor agency, has achieved a 14 ­percent reduction in blood use among orthopedic patients since 2011.

The Realtor from White Bear Lake was on such heavy pain medication during her postoperative recovery that she was hallucinating. So she can’t recall if doctors ever talked about a transfusion.

“In the end,” she said, “I guess my body just did what they hoped it would do and reproduced the blood.”

Labey had discussed banking some of her blood before surgery, because transfusions of patients’ own blood can be safer. But she didn’t have enough time before the surgery to replace the lost blood.

The reduced demand for blood has created dilemmas for the Twin Cities’ two blood donor agencies, Red Cross and Memorial. They have cut back collection events by 10 to 20 percent and reduced staff, primarily through attrition.

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  • Bob Evander chatted with phlebotomist Tessa House as he donated platelets at the Memorial Blood Center in St. Paul. Hosptials in the Twin Cities have greatly reduced their blood use for transfusions as views on who needs blood after suregery have changed.

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