MDs rethink blood transfusions

BRIDPORT — A team of topnotch doctors from around the world landed in Bridport at the end of February to reexamine commonly held medical beliefs about blood transfusions.
The four-day conference took place from Feb. 26 through March 1, and included doctors from as far afield as Austria and Australia. At the heart of their research is the concern that blood transfusions are risky, expensive and often unnecessary — and yet, they continue to be done frequently in American hospitals and around the world.
Now, they hope to prove that dialing back the number of blood transfusions given to patients could have positive outcomes for patient health.
For doctors interested in new blood management research, questioning the usefulness of blood transfusions in modern medicine can sometimes feel like swimming upstream. Transfusions have been widely popular since the world wars of the 20th century, when they were used in army hospitals to treat soldiers. 
As of 2006, there were about 15 million units of blood transfused per year in the United States. But doctors concerned about blood management say that number is too high.
“In the case of transfusions, the estimates are that at least 50 or 60 percent may be unnecessary for patients,” said nurse Sherri Ozawa, the clinical director of the Institute for Patient Blood Management and Bloodless Medicine at a New Jersey hospital.
Ozawa was one of the eight primary participants in Bridport conference, which was hosted by the Society for the Advancement of Blood Management, and the Medical Society for Blood Management. Bridport became the unlikely hub for international research on this front because the lead investigator on the project, Dr. Aryeh Shander, owns a house there on Lake Champlain.
Ozawa and some of her colleagues believe that the use of blood banks and transfusions in modern medicine hasn’t been properly examined in decades. Blood has never been treated the way that new drugs or pharmaceutical products have been tested, Ozawa said, and the prevalence of blood transfusions — particularly during or after routine surgeries — puts patients at unnecessary risk with no proven benefit.
Risks of transfusions include increased risk of death, heart complications, and longer stays in the hospital, Ozawa said.
“If blood went to the FDA today,” Ozawa said, “it would never make it to market.”
That said, she thinks physicians and patients both perceive blood in a different way than they perceive drugs like insulin. The act of donating blood is tied up in emotions, patriotism and love of country.
Ozawa is a believer in “patient blood management,” an approach to medicine that tries to prevent the need for blood transfusions.
“The concept is that there are those circumstances where blood is the appropriate treatment,” Ozawa said. “However, with all the other techniques that exist, most of the time transfusions become unnecessary.”
One such example is elective surgery: In 50 percent or more of elective surgeries, patients receive blood transfusions during or after surgery. New technology, though, includes machines that reduce bleeding during surgery at the site of the incision. Other options include recirculating a patient’s own blood that might be lost during the surgery.
A third option would be simply acknowledging that humans can tolerate a certain amount of anemia, a condition in which the body does not have enough red blood cells for a period of time.
Ozawa and her colleagues are not alone in their interest in blood management: Other doctors and organizations like the Red Cross are paying attention, too.
“In essence, anytime anyone gets a transfusion it should be something that they truly need,” said Dr. Patricia Pisciotto, the chief medical officer of the northeast division of the American Red Cross.
Pisciotto did say that it’s hard to paint a black-and-white picture of when a patient may or may not need a transfusion. But she said it’s important for doctors to find ways to conserve blood when they can.
“There’s always going to be a need for blood,” Pisciotto said, pointing out that while doctors may be able to prevent the need for transfusions in elective surgeries there will always be trauma situations when blood is necessary.
“If we’re careful with the resource that we have, hopefully the blood shortages would go away,” Pisciotto said.
Meanwhile, what Ozawa and her colleagues are proposing is to build an international database to study patient outcomes when blood management is used. Because doctors can’t study blood in the same way they study drugs — through double blind studies controlled with placebos — she’d like to see a study conducted retrospectively by looking at historical outcomes.
She related the proposal to the study of cigarette smoking: Over time, she said, patterns emerged that clearly demonstrated the dangers of smoking. She hopes such patterns about blood management could become similarly clear.
At what Ozawa called a “seminal meeting of the minds” in the blood management field, medial experts in Bridport refined their vision for the database. So far, the early examples of blood management studies are encouraging. For Instance, Ozawa’s hospital, Englewood Hospital and Medical Center, built a cardiac surgery program about 10 years ago with blood management at the foundation of their philosophy.
Ten years later, the unit has one of the lowest mortality rates, and lowest rates of complications, of any hospital in New Jersey.
“By being conservative (with blood transfusions), our outcomes are better,” Ozawa said.
She hopes the database will be up and running in the next year or so. From there, Ozawa is hopeful about what blood management on a broader scale could mean. Blood management could curtail blood shortages by reserving the treatment for the appropriate patients. Hospitals — who pay blood banks for the blood they use — could save money, and patients could avoid unnecessary risks.
“There’s a win-win,” Ozawa said.
Reporter Kathryn Flagg is at [email protected].

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