Navigation Links
Johns Hopkins rewrites obsolete blood-ordering rules
Date:5/22/2013

Johns Hopkins researchers have developed new guidelines the first in more than 35 years to govern the amount of blood ordered for surgical patients. The recommendations, based on a lengthy study of blood use at The Johns Hopkins Hospital (JHH), can potentially save the medical center more than $200,000 a year and improve patient safety, researchers say.

A report on the research that led up to the new guidelines, published online in the journal Anesthesiology, suggests millions of dollars a year nationwide could be saved in laboratory costs and wasted blood if other hospitals also reconsider how they prepare blood for surgery.

The researchers say the guidelines ensure that blood is readied for surgeries likely to require transfusions and that time isn't spent preparing blood for surgeries that rarely require them.

"In 1976, when the last guidelines were published, there were 60 surgical procedures on the list. Now, with the addition of laparoscopy, robotic surgery and other minimally invasive techniques, there are 135 categories of surgical procedures," says study leader Steven M. Frank, M.D., an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. "Blood loss has declined over time as surgery has evolved, but the guidelines were never reconsidered, leading to a lot of unnecessary work to prepare blood for surgery."

Frank and his colleagues analyzed computerized anesthesia records including blood use for 53,000 surgeries performed at JHH over the course of 27 months from January 2010 through March 2012. They looked at how often blood transfusions were needed during various types of surgeries, and how much blood was transfused. Then they devised a new mathematical formula to determine whether patients undergoing each type of surgery would most likely need no blood, which ones might possibly need blood (for which a sample was sent to the lab to get the patient's blood type and other information) or whether blood was very likely to be needed.

In cases where the algorithm "guessed wrong," Frank notes, emergency blood (type O-negative) can be procured within minutes with minimal risk of reaction. That scenario occurred in three out of every 1,000 cases, he says, but those patients had substantial anemia prior to surgery, a condition for which blood should be ordered anyway, despite the new recommendations.

Surgeries unlikely to require transfusions include appendectomy, tonsillectomy, thyroidectomy (removal of the thyroid) and removal of the gallbladder. He says that in 1,605 cases of thyroid removal over the study period, only three transfusions were needed.

"What we've found is a better-safe-than-sorry approach that isn't actually helpful," Frank says. "We haven't transfused a thyroidectomy in over two years at our institution, so there's a huge opportunity to save money by following our new guidelines."

He says that when blood is ordered for a surgical case, there are expenses associated with typing a patient's blood and screening for various antibodies to ensure a good match is found, as well as with preparing the actual units and bringing them to the operating room. Time spent preparing blood for, say, thyroid removal could be better spent preparing blood for open-heart surgery, where several units of blood will likely be required.

Meanwhile, he adds, unused blood set aside for surgical patients is removed from the available pool for 24 hours, and while it can be used eventually, recent research by his team suggests that blood stored longer than three weeks begins to lose the capacity to deliver oxygen-rich cells where they may be needed most.

In some cases, he notes, JHH was under-ordering blood, a condition also remedied by the new set of guidelines. Liver transplants are most likely to require the largest amount of blood, with the recommendation that 15 units be prepared and in the operating room.

Frank says that while the blood-ordering guidelines developed are specific to JHH, they can be adapted to other hospitals. Also, he says, hospitals with computerized anesthesia records roughly 50 percent of hospitals in the United States can use the algorithm developed by the Johns Hopkins team to develop their own hospital-specific guidelines.


'/>"/>

Contact: Stephanie Desmon
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medicine
Source:Eurekalert

Related medicine news :

1. Exposure to Secondhand Smoke May Lead to Worsening of Pediatric Kidney Disease; Pediatric Nephrology Publishes Dayton Children’s, Johns Hopkins Joint Study
2. Former Johnson & Johnson Executive Brian Perkins Named Chairman of Puroast® Coffee
3. Schachter, Hendy & Johnson PSC Lawyer Says Cochlear Implant Victims Should Know Their Legal Rights
4. Injury Law Firm Announces New Informative Graphic on Common Medicines That Have Allegedly Been Linked to Stevens Johnson Syndrome
5. Parker Waichman LLP Responds to Johnson & Johnson’s Decision to Discontinue Some of Its DePuy All-metal and Ceramic-on-metal Hip Implant Products
6. DePuy Pinnacle Hip Implant Lawsuit News: Bernstein Liebhard LLP Comments on Johnson & Johnson Decision to Stop Metal-on-Metal Hip Sales
7. Johns Hopkins experts to present genetics advances at international meeting this weekend
8. Johnson & Johnson Ethicon Transvaginal Mesh Lawsuits Update: Resource4thePeople Reports Judge Schedules More Trials for This Summer
9. Carey Danis & Lowe Optimistic About DePuy ASR Hip Lawsuits Following Johnson & Johnson Loss
10. Sun Yat-sen University and Johns Hopkins sign collaboration agreement
11. US Drug Watchdog Now Urges Any Woman Who had A Out Of The Blue Stroke Or Heart Attack After Using Birth Control Pills Call Yaz, Or Yasmin to Call the Johnson Law Group
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... ... June 25, 2016 , ... First Choice Emergency Room ... Dr. Sesan Ogunleye, as the Medical Director of its new Mesquite-Samuell Farm facility. ... of our new Mesquite location,” said Dr. James M. Muzzarelli, Executive Medical Director of ...
(Date:6/25/2016)... ... ... Conventional wisdom preaches the benefits of moderation, whether it’s a matter of indulgence ... high can result in disappointment, perhaps even self-loathing. However, those who set the bar ... from PsychTests.com reveals that behind the tendency to set low expectations is ...
(Date:6/24/2016)... ... ... Marcy was in a crisis. Her son James, eight, was out of control. Prone to ... , “When something upset him, he couldn’t control his emotions,” remembers Marcy. “If there ... my other children and say he was going to kill them. If we were ...
(Date:6/24/2016)... ... 24, 2016 , ... Comfort Keepers® of San Diego, CA is excited to ... Recovery® program to drive cancer patients to and from their cancer treatments. Comfort ... quality of life and ongoing independence. Getting to and from medical treatments is ...
(Date:6/24/2016)... New York, NY (PRWEB) , ... June 24, ... ... lifestyle publication Haute Living, is proud to recognize Dr. Barry M. Weintraub as ... believes that “the most beautiful women in the world, and the most handsome ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016 Dehaier Medical ... the "Company"), which develops, markets and sells medical devices ... , signed a strategic cooperation agreement with Hongyuan ... "Hongyuan Supply Chain") on June 20, 2016, to develop ... the strategic cooperation agreement, Dehaier will leverage Hongyuan Supply ...
(Date:6/24/2016)... Mass. , June 24, 2016   Pulmatrix, ... pharmaceutical company developing innovative inhaled drugs, announced today that ... Russell Investments reconstituted its comprehensive set of ... "This is an important milestone for Pulmatrix," ... will increase shareholder awareness of our progress in developing ...
(Date:6/23/2016)... Research and Markets has announced the ... to 2022" report to their offering. ... patients with kidney failure, it replaces the function of kidneys ... blood and thus the treatment helps to keep the patient ... Increasing number of ESRD patients & substantial ...
Breaking Medicine Technology: