Monday, March 5, 2018

Rational use of blood: Jaroorat bhi hai kya?

RBC transfusions are now decreasing in hospitals in the US after steadily increasing for more than 2 decades. "From 2011 to 2014, statistically significant reductions in RBC transfusions were seen among all sexes, race/ethnicities, patient risk severities, payer types, and admission types," Ruchika Goel, MD, MPH, from the Department of Pathology at Weill Cornell Medical College in New York City, and colleagues wrote a large, population-based report published in JAMA.

More hospitals have launched blood management programs to restrict transfusions.

The percentage of hospitalized patients who received RBC transfusions decreased from a peak of 6.8% in 2011 to 5.7% in 2014. At the same time, the proportion of patients who received a plasma transfusion went from 1.0% in 2011 to 0.87% in 2014.

Among elective admissions, the relative decline in RBC transfusions was significantly larger (26%) than for nonelective admissions (14%).

Human blood is covered under the definition of “Drugs” under Section 2(b) of Drugs and Cosmetics Act.

All over the world, there is a movement for rational use of drugs. So, when we talk of rational use of drugs, blood and blood products are a part of the discussion. This is how you can do it.

  • Transfuse blood only when it is required.
  • If only one unit is required, avoid transfusing blood
  • If two units are required, transfuse one.
  • If hemoglobin is more than 7, give a trial of intravenous iron first.
  • All elective surgeries should be given IV iron to build up hemoglobin preoperatively. Not doing so may mean deficiency in service.
  • Autologous blood transfusion is another answer.
  • NABH should consider rational use of blood transfusion as one of the criteria in accreditation of a hospital. A good hospital is one which uses minimum blood transfusions.

If hospitals in the US can reduce blood transfusions, why can’t we?

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