There's no debate that blood transfusions can play an important role in the healing process for patients undergoing surgery, receiving treatment for an illness or recovering from a serious injury. However, emerging evidence has shed light on lesser-known dangers associated with blood transfusions – and that has caught the attention of the Northwest Community Hospital's Blood Management Committee.
Recent retrospective studies examining the safety and effectiveness of blood have indicated that there may be potential deficiencies in units of packed red blood cells stored longer than 14 days. Evidence gathered by a Cleveland Clinic study suggests that older units of blood may lack certain substances or have degraded compounds that compromise effectiveness of the component and contribute to complications.
"Along with the traditional risks associated with blood transfusions, these findings bring forth a new wave of evidence that physicians should take into consideration when administering blood," says Angelo Milano, MD, Chief of Pathology at NCH.
Dr. Milano explains that blood units that are deemed appropriate for transfusion – but nearing their storage maturity – carry risks that may put the patient in danger. If red blood cells aren't retaining their natural characteristics then they may be a hindrance to maintaining blood oxygen levels, potentially causing ischemic damage, especially to the kidneys.
With 8,600 units of packed red blood cells administered to NCH patients last year, these new findings captured the attention of the Blood Management Committee, which oversees blood usage and promotes safe blood transfusion practices.
Panayota Kleinman, MD, medical director, stresses that blood usage should not be taken lightly. "Doctors are urged to be more judicious about what they administer and when," she explains.
Because of the inherent dangers of blood transfusions, the minimal amount of blood should always be administered in order to reduce the risk of kidney damage or pulmonary edema resulting from post-transfusion complications such as transfusion related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO).
When considering blood transfusions, doctors should follow the guidelines for reasonable indications for giving blood, which are found within the I-FORM on CPOE. "We're looking to reduce the over-administration of blood and to reserve it for the proper situations," adds Dr. Kleinman. "Our current goal is to avoid routine transfusions until the Hgb is less than seven."
Additional information about blood transfusion safety at NCH will be forthcoming. Copies of these recent studies are available in the Medical Staff Services office. If you have questions or concerns, please contact Dr. Milano at 847.618.6168.