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
|Contact: Stephanie Desmon|
Johns Hopkins Medicine