Johns Hopkins rewrites obsolete blood-ordering rules

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.

Blood transfusion: a practical guide

Introduction

Over 2 million units of red cells are transfused in the UK every year, half of which are used for surgical patients. A successful transfusion is the appropriate provision of blood cells or other blood components in a safe and timely manner. This article gives a practical guide to transfusion medicine.

Blood groups