For years, most physicians and hospitals rarely thought about the amount of blood transfused – unless there was a shortage. Yet strong evidence suggests blood transfusions can lead to longer recovery times, longer hospital stays, increased morbidity 1, 2, 3, 4 and increased infections 5.

Providing universal access to blood supplies is a key objective for global health agencies.  However, there is little evidence 6 from randomised controlled trials on what types of patients benefit from blood transfusions, what blood products should be transfused, and how much patients should receive. With recent development of quality–performance indicators for patient blood management by health-care institutions and accreditation organisations, there will be greater scrutiny on transfusion practices.

Patient blood management encompasses an evidence-based medical and surgical approach that is multidisciplinary (i.e., including transfusion medicine specialists, surgeons, anaesthesiologists, and critical care specialists) and multi-professional (i.e., including physicians, nurses, pump technologists and pharmacists). In this approach, preventive strategies are emphasized:

  • to identify, assess, and manage anaemia in medical and surgical patients, including use of pharmacological interventions
  • to avoid unnecessary diagnostic testing to minimise iatrogenic blood loss
  • to optimise homoeostasis and use of point-of-care testing
  • to establish clinical practice guidelines for blood transfusions.

A collection of Cochrane Reviews and a Lancet Review summarises the evidence for the safety and effectiveness of interventions to reduce the need for blood transfusion. For some interventions the evidence is strong:

Are you rethinking your blood TRANSFUSION strategy?

Is your patient asking you about donating their blood for surgery? See this summary for the latest evidenced based information about PAD.