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Using Blood Wisely aims to reduce inappropriate blood transfusions

Blood is a precious, non-renewable resource and should therefore be used as carefully and appropriately as possible, says a Regina physician who is part of a national campaign called Using Blood Wisely.

Dr. Ryan Lett, an anesthesiologist and physician lead for the Patient Blood Management Program, notes physicians have historically been conditioned to think they need to transfuse two units of red blood cells when only one may be required, or transfusions must be done at higher hemoglobin thresholds than necessary.

The aim of the Using Blood Wisely campaign is to dispel myths around these common practices and encourage physicians to decrease inappropriate red blood cell transfusions. It starts with changing habits, Dr. Lett said.

“There’s a lot of habit that is built into physicians’ practice and like any habit you need to identify a trigger and a rationale that addresses those issues, and if you can address those issues then you can change the habit,” he said.

Physicians may think if they are going to use one unit of blood for transfusion, they might as well use two. However, studies have shown adverse reactions, including transfusion associated circulatory overload in one to six per cent of adults in ICU.

“We know from multiple randomized control trials that more blood doesn’t convey any benefits to the patient, and if there is no benefit to the patient, the only possibility for an outcome is an adverse one,” Dr. Lett said.

The other issue concerns hemoglobin results. Physicians commonly transfuse red blood cells at certain levels because they have always done it that way. However, in stable, non-bleeding patients, transfusions are generally not necessary when hemoglobin is 70 g/L or greater, Dr. Lett said, and even then, iron and other nutritional deficiencies should be addressed first.

“For many clinicians, when we see a hemoglobin result, there is a conditioned response where we spend less time thinking about what we’re doing and more time repeating what we have previously done. That’s just a human reaction. We try to save cognitive battery life, if you want to call it that, by batching decisions that we’ve made multiple times in the past and repeating them multiple times in the future. We may not look for a better way to manage the problem, which in this case is anemia.”

Using Blood Wisely is a joint campaign by Saskatchewan’s Choosing Wisely program, Choosing Wisely Canada, Canadian Blood Services, and the Canadian Institute of Health. Hospital clinicians are challenged to decrease inappropriate red blood cell transfusions and compare their hospital practices to national benchmarks. The challenge involves conducting a spot audit by Dec. 1, 2020, that shows:

  • At least 65 per cent of red blood cell transfusions are single unit
  • At least 80 per cent of inpatients have pre-transfusion hemoglobin of 80 g/L or less
  • The practice is maintained for four months

Hospitals can receive national recognition by becoming a designated Using Blood Wisely Hospital, and the initiative can be acknowledged for organizational quality improvement by Accreditation Canada’s Qmentum Program.

For more information, an introductory webinar will be held Sept. 30, 2020, at 10 a.m. CT.

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