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By analyzing data from unspecified clinical trials comparing blood pressure methods, the Johns Hopkins experts, along with colleagues at the Cleveland Clinic and NYU Langone Medical Center, agrees with recommendations for blood transfusions that reduce blood use to improve patient safety and outcome Publish this week on JAMA Internal Medicine, the report also provides an instruction on how to launch a patient blood management program.
“In summary, there is no benefit to opening more blood than is necessary and some clinical trials have actually shown harm to patients,” he said. Steven Frank, MD, professor of anesthesiology at Johns Hopkins University School of Medicine. “All it does is increase risks and costs without added benefits,” he added.
As explained in current guidelines and reviews of clinical trials, the report reinforces these recommendations:
- Strong adult patients, including critically ill patients, with hemoglobin levels of 7 g / dL or higher should not be switched.
- Patients undergoing orthopedic or cardiac surgery, or patients with underlying heart disease with hemoglobin levels of 8 g / dL or higher should not be replaced.
- Patients with strong and inactive bleeding should be transferred to a blood unit and then re-examined.
The clinical trials reviewed compared so-called liberal versus blood transfusion prevention. Liberal transfusions are given to patients with 9 to 10 grams of hemoglobin per tenth liter, or deciliter, of blood volume, while transfusion inhibitors are given to patients with 7 to 8 grams per deciliter. Many of the clinical trials reviewed by this tem used the number of patients who died within the 30- to 90-day post-transfusion window as a measure of patient outcome.
Of the more than 8,000 patients included in the eight clinical trials reviewed, there was no difference in mortality between liberal or restrictive blood transfusions. A clinical trial found an increase in mortality associated with liberal transfusion, and increased blood clotting in the liberal cohort in a study involving patients with brain damage.
“These recommendations do not apply to patients with severe coronary syndrome, severe thrombocytopenia and chronic dependent anemia, including sickle cell, because we have not found sufficient evidence for patients with as in this condition, “Frank said.
The team also found that most trials reduced the amount of blood used by 40 to 65 percent. Earlier this year, Frank reported the results of a four -year project to implement a blood management program throughout the Johns Hopkins Health System, which would reduce blood use by 20 percent and save more than $ 2 million in costs a year.
“As members of the High Value Practice Academic Alliance, we recognize the importance of launching evidence-based recommendations for openness. Our analysis provides evidence to ensure providers are restricting practice. open actually improves the quality and safety of patient care, while providing significant reduction in health care spending and increasing blood supply for patients at risk of bleeding life, ”says Frank .
Funding for The Johns Hopkins Hospital’s blood management program is provided by the Johns Hopkins Health System and Armstrong Institute for Safety and Quality. The authors are members of the High Value Practice Academic Alliance, a consortium of more than 80 partner institutions in the United States and Canada, with clinicians from 27 specialties and subspecialties working to improve high value health care.
Authors of this paper:
Divyajot Sadana and Moses Auron of the Cleveland Clinic Foundation; Ariella Pratzner, Harry Saag, Nicole Adler and Frank Volpicelli of NYU Langone Health; and Lauren Scher and Steven Frank of Johns Hopkins Medicine.