Their proposed alternative: patient blood management, a collection of medical practices and surgical techniques to help doctors minimize blood loss and avoid transfusions. And some have set their sights even further to bloodless medicine, which requires doctors to carry out normal medical procedures—including surgery—without transfusing the patient with blood, red cells, plasma, or platelets.
Patient blood management, a concept that first emerged around15 years ago, emphasizes preventative measures to reduce the risk of a patient needing a transfusion. For example, physicians practicing blood management might screen and treat patients for anemia in the weeks before surgery; during an operation, they might use medications or certain techniques to minimize bleeding.
Because a blood transfusion can have complications, blood-management proponents argue that avoiding the practice altogether is in patients’ best interest. Even if the blood is the right type, for example, a patient can have an allergic reaction to the blood itself. Multiple transfusions can cause an overload of iron in the body, damaging the liver or heart. In very rare cases, transfusion can also cause graft-versus-host disease, a condition where white blood cells in the new blood attack the bone marrow.
So, they’re asking: If doctors can avoid a transfusion, why wouldn’t they?
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In 1984, the HIV virus was identified; in 1989, the Hepatitis C virus. As major infectious threats to the national blood supply became more prevalent, the medical field took a closer look at how it was handling blood.
“For many years, the emphasis was on making blood safer,” says Eduardo Nunes, the senior director of standards, advocacy, and patient blood management at the AABB (a membership organization for the field of transfusional medicine, formerly known as the American Association of Blood Banks). In 1997, the U.S. Department of Health and Human Services founded the Advisory Committee on Blood and Tissue Safety and Availability; the following year, the AABB founded the National Blood Data Resource Center to compile data on blood donation and transfusion.
But more recently, Nunes says, attention has shifted: “Now, our focus is on being more efficient in our use of blood products.” In 2005, the organization changed its name from “American Association of Blood Banks” to reflect a widening focus. In the years that followed, AABB—which is the main accrediting body for blood banks and transfusion programs in the U.S.—ramped up its educational offerings on blood management for members. Last year, the organization published its first set of guidelines for patient blood management.
Nunes says the new guidelines will serve as the basis for a new blood-management accreditation program that AABB plans to launch in the near future, and that it hopes will significantly increase the number of hospitals that practice blood management.