Blood Transfusions Are One of the Most Overused Procedures in Medicine

Illustration for article titled Blood Transfusions Are One of the Most Overused Procedures in Medicine

Blood transfusions have saved countless lives. But blood transfusions can be risky. Emily Anthes writing in Nature gathers the evidence that the procedure is one of the most overused treatments out there, an expensive, but more importantly, potentially dangerous, problem.

It’s intuitive to understand why blood transfusions are good. When blood banks that arose out of World War II proved their use, doctors began adopting transfusions widely—without randomized clinical trials to back up many of the practices. “I think we were kind of brainwashed into thinking that blood saves lives, and the more you give the better,” anesthesiologist Steven Frank told Nature.

Lately, doctors have been trying to curb the practice. At Stanford Hospital and Clinics, doctors were prompted to reduce the number of transfusion requests, which ended up cutting costs by by $1.6 million and reducing length of hospital stays and mortality for patients.

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More compelling than the money saved is the the fact that blood transfusions can do serious damage: There is the low, but not zero, risk of receiving infected blood, and then there is the complicated way in which foreign blood interacts with the immune system. Categorizing blood into different types (A, B, AB, O and positive/negative) is supposed to prevent harmful immune reactions, but it doesn’t always. Read more about the overuse of blood transfusions in Nature.

[Nature]

Top image: Praisaeng/shutterstock

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DISCUSSION

There are a lot of issues around this in medicine. The OR is another area it is challenging, from the anesthesia perspective it is our responsibility to monitor and compensate blood loss. However, the methods for accurately measuring true blood loss are far from perfect. Many ORs have methods depending on the facility that may range from measured drapes and suction containers to basically eyeballing. It’s also hard to accurately know how much blood is in that pile of blood-soaked gauze. I’ve examined numerous studies about the under and over estimation of blood loss. Transfusions pose unique risks to individual patient populations/diagnosis groups. At least we have the option, hopefully methods to improve upon this surface in the near future. Many facilities will only transfuse for Hgb of 7 g/dL which is down from not long ago where most anyone at 10 or lower would be transfused.