Blood, still saving lives but...there are risks - Patient Blood Management

Summary

The video script discusses the shift in clinical practice regarding blood transfusions, emphasizing the need for patient-focused blood management over product-focused approaches. Studies reveal that red blood cell transfusions may increase morbidity and mortality, and are only beneficial in a small percentage of cases. The script highlights the complexities of blood as a biological fluid and the emerging understanding of its impact on microcirculation, suggesting that current transfusion practices may be contributing to adverse clinical outcomes and require re-evaluation.

Takeaways

• 🩸 Fresh blood transfusions are deeply ingrained in clinical practice, often given to alleviate physicians' discomfort rather than addressing the patient's needs.
• 🔄 There is a need for a paradigm shift in transfusion medicine, moving from a product focus to a patient focus, which is the essence of patient blood management.
• 📉 Studies have shown that red blood cell transfusions can be harmful in certain clinical situations, with increased mortality and morbidity risks.
• 📚 A significant review by Marik and Koren in 2008 found that in most cases, the risks of red blood cell transfusions outweighed the benefits.
• 🧬 Blood is a complex biological fluid, and understanding the biochemical and biomechanical changes that occur during storage is crucial for better clinical implications.
• 🔬 Research by Dr. Andreas Maia and colleagues used a situ camera to observe the effects of transfusion on microcirculation, revealing reduced flow and uneven distribution of red cells.
• 🚫 The clinical implications of transfusing stored blood are still not fully understood, suggesting a need for caution and further research.
• 📉 Key lessons for clinicians include the ability to correct anemia without blood products, the potential to reduce perioperative blood loss, and the importance of post-operative treatment for anemia.
• 🚨 Allergenic blood transfusions have a wide range of potential adverse clinical outcomes, highlighting the importance of re-evaluating current transfusion practices.
• 🛑 Maintaining the status quo in transfusion practice is not acceptable in the context of current safety and quality standards, indicating an urgent need for change.

Q & A

Why are fresh blood transfusions sometimes given to alleviate physicians' discomfort rather than addressing the patient's needs?

Fresh blood transfusions are ingrained in clinical practice, and in some cases, they are administered due to physician discomfort or habit rather than being strictly necessary for patient care.

What is the current state of transfusion medicine practice?

Transfusion medicine practice is based on behavior and habits that often need to change, with a shift required from a product focus to a patient focus, which is referred to as patient blood management.

What did Tinmouth and colleagues find in their 2006 analysis regarding red blood cell transfusions and patient outcomes?

Tinmouth and colleagues found an association between red blood cell transfusions and increased mortality and morbidity in critically ill patients, indicating a paradigm shift in the perception of transfusions from beneficial to potentially harmful in some clinical situations.

What did Marik and Koren's 2008 review of 45 studies conclude about the risks and benefits of red blood cell transfusions?

Marik and Koren concluded that in the majority of cases reviewed, the risk of red blood cell transfusion outweighed the benefits, with only a subgroup in one study showing benefits outweighing the risks.

What did the first international consensus conference on transfusion outcomes find regarding the benefits of transfusions across 495 studies?

The conference found that in 59% of clinical scenarios, transfusions were not beneficial at all, and in 29% of cases, the benefits were uncertain, with only 12% of the populations showing that transfusions were helpful.

Why is blood considered a complex biological fluid in the context of this script?

Blood is considered complex due to the multiple biochemical and biomechanical changes that occur once it is removed from the host and stored, with clinical implications of transfusing stored blood only beginning to be understood.

What did Dr. Andreas Maia Hellman and colleagues observe in their study of sublingual microcirculation before and after transfusion?

They observed reduced flow, swollen single-cell capillaries, uneven distribution of red cells, blockage, sludging, and areas with no red blood cells in contact with tissues after transfusion of stored red blood cells.

What three key lessons did clinicians learn from the experiences and studies mentioned in the script?

The three key lessons are: 1) Profound anemia can be corrected without blood products, 2) Perioperative blood loss can be significantly reduced, and 3) Post-operative treatment of symptomatic anemia should be universally applied to restore the patient's endogenous red cell volume.

What is the potential range of adverse clinical outcomes associated with blood transfusion according to the script?

Blood transfusion has the potential for a wider range of adverse clinical outcomes than probably any other medical intervention.

What conclusion did the script draw after considering all available evidence on transfusion and outcome?

The conclusion is that transfusion is a major multiplier of morbidity and mortality, and maintaining the current practice would not be accepted or tolerated in any other field of medicine.

In what context does the script suggest that the status quo of transfusion practice should not be maintained?

The script suggests that the status quo should not be maintained in the context of current safety and quality standards in medicine.