In keeping with a national trend, Stanford Hospital & Clinics has significantly reduced its use of precious blood supplies in recent years. The trend reflects a growing awareness that while blood may be life-saving, it also carries risks to patients, an important consideration in deciding whether a patient should receive a transfusion, said Lawrence Goodnough, MD, a professor of pathology and hematology at Stanford.
Goodnough, who directs the transfusion service at Stanford Hospital & Clinics, recently wrote a commentary and co-authored two papers in the Lancet (subscription required) about trends in blood use and blood alternatives.
Four years ago, Stanford Hospital launched a program that has made doctors think twice before they order blood for a patient. Now, every time a doctor requests blood through the hospital’s electronic medical record system, a pop-up alerts the clinician to guidelines on blood use and asks him or her to explain the reason for the request. Physicians then may reconsider or cancel the order.
The system contributed to a 24 percent decline in use of red blood cells at the hospital between 2009 and 2012. Transfusions of all blood products at the hospital fell from more than 60,204 to 48,678 during that time. Goodnough said, "Here we are leveraging electronic medical records to reverse this national trend toward overutilization and motivating people to follow a more restrictive blood practice."
The decline reflects a national trend. At a meeting earlier this month of the International Society of Blood Transfusion, officials at the American Red Cross, which supplies about half of the nation’s blood, said blood use fell by 3 percent in 2011 and another 5 percent in 2012, said Goodnough, who attended the meeting.
There are currently no standard guidelines for blood use and some controversy about what levels of hemoglobin should trigger a transfusion, leading to wide variability in blood utilization around the country, Goodnough said. He believes each patient’s situation should be considered individually.
“I don’t think there is one laboratory value that should be used. Older patients may be different than younger patients, for instance,” he said. “So the message is that there is not one number. We should use a restrictive transfusion philosophy — when the treating team is convinced that the benefits of transfusion would outweigh the risks.”
For more discussion on the latest study, read this Inside Stanford Medicine article from today.
Previously: New issue of Stanford Medicine magazine asks, What do we know about blood?, Retro arcade-style video promotes blood donation and Woman’s story of her son’s hereditary spherocytosis highlights the importance of blood donation
Photo by El Alvi