Hospitals cutting back on transfusions

With blood costs high, and concerns over blood safety growing, hospitals are developing tougher rules for when it's appropriate to provide transfusions. They're also riding herd on doctors to make sure they actually follow suit, a step many hospitals fail to take when implementing new policies in fear of aggravating a powerful constituency.

The changes come partly because a growing body of evidence suggests that transfusions may not be as safe as the industry would hope. Research has increasingly suggested that donated blood causes changes in the recipient's immune system that lead to higher infection rates, complications and even death.

Hospitals' new rules restricting the use of transfusions include checking patients for anemia before surgery, and if they are anemic, treating them with iron or red-blood-cell-boosting drugs so transfusions are less likely to be needed in the operating room. Hospitals are also taking steps to prevent anemia from emerging in the first place. For example, some are no longer having patients donate their own blood weeks before surgery, which can trigger anemia, and instead, are recycling patients' own blood by collecting it in the operating room for immediate re-infusion.

In developing their clinical standards, hospitals are being guided, in part, by a 19-point program developed by the Joint Commission, designed to help hospitals decide whether they're managing their blood supplies properly and administering blood safely to patients.

However, it's clear that money, not just clinical consideration, is driving some of these changes as well. The cost of a unit of blood has more than doubled over the past 10 years, and what's more, hospitals spend an estimated $25 billion to buy, process and transfuse about 30 million units a year.

To learn more about hospitals' transfusion control initiatives:
- read this Wall Street Journal piece

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