Virginia Commonwealth Univeristy

Practicing Excellence in Transfusion Therapy

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Statue of Hippocrates at Virginia Commonwealth University

VCU program educates health care providers about blood conservation

The Virginia Commonwealth University Medical Center is working to educate health care providers about transfusions, specifically providing new published data that shows that reducing the number of transfusions performed for certain patient populations is not only safe, but can actually improve outcomes.

The Practicing Excellence in Transfusion, or PET, program was started about six years ago in an effort to educate providers how to administer blood products only to those patients who can truly benefit from it. It is the first program of its kind in Virginia.

Blood transfusion is a procedure in which the patient receives blood through an intravenous line inserted into one of the blood vessels. The procedure is used to replace blood lost during surgery or a serious injury. A transfusion might also be done if the patient’s body can’t make blood properly due to an illness or when the blood forming cells are affected by chemotherapy.

According to the National Institutes of Health National Heart Lung and Blood Institute, almost five million blood transfusions per year are performed in the United States.

“Research has been done that shows transfusions may not be necessary in all cases where they are performed,” said Mary Jane Michael, RN, PET nurse coordinator. “In certain cases, transfusion is very appropriate and is a life-saving therapy, however, physicians should know when and how it will benefit each individual patient. As we learn more about the risks and benefits, these decisions need to be thought about very carefully.”

Certain viral infections used to be considered the main risks of transfusion, however some of those have been markedly reduced through testing. Other risks now predominate, including changes in the patient’s immune system that can lead to higher infection rates than those seen in non-transfused patients. This often causes longer hospital stays or return trips to emergency departments after hospital discharge. In addition, bacterial infection and certain respiratory reactions remain the leading causes of death from transfusion.

“It is important to consider each patient individually and to determine the best transfusion protocol based on that patient’s medical treatment,” said Susan Roseff, M.D., professor in the Department of Pathology and director of Clinical Pathology. “We have learned that more isn’t always better when it comes to blood transfusion – sometimes patients who are not transfused do better.”

At the VCU Medical Center, the PET program aims to reduce the number of transfusions through educating its medical professionals about transfusion guidelines and blood conservation techniques. For example, transfusion rates in the VCU Department of Orthopaedic Surgery for total joints have dropped dramatically after targeted education.

“We also have a low rate of transfusion for heart surgery,” said Bruce Spiess, M.D. professor in the VCU Department of Anesthesiology and part of the PET staff. “From our PET program, the Virginia Cardiovascular Surgery Quality Initiative, VCSQI, has instituted a blood management program that over a two year period, saved more than $45 million in the state.”

The VCU Medical Center has a group of surgeons who specialize in no-blood surgeries where techniques to limit the need for transfusions are followed before, during and after surgery. These techniques include optimizing hemoglobin prior to surgery and specialized equipment that washes, cleans and transfers the patient’s own blood back into their body during surgery. In some cases, a smaller, portable version of this same type of equipment is used after surgery at the patient’s bedside.

The PET program has also made strides in reaching physicians on a wider scale to discuss when and when not to perform blood transfusions. The program hosted two conferences to educate health care providers from the entire Mid-Atlantic region. The conferences featured national experts who provided the most recent data demonstrating improved patient outcomes, lower costs and reduced risk associated with implementing a hospital-wide blood conservation program.

In the coming years, it may become even more important to conserve the nation’s blood bank. Sixty percent of transfusions are performed on patients aged 65 and older while the majority of donors are 18 to 25 years old. The fear is that as the population ages, the blood supply may actually decrease. VCU Medical Center works closely with Virginia Blood Services and encourages donors to respond to community blood drives.

“Blood is a resource we need to think about and use wisely and appropriately,” said Michael.

For more information about the PET program at the VCU Medical Center, visit www.petproject.pathology.vcu.edu