June 22, 2018
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Aussies visit EMMC for lessons in blood management

By Meg Haskell, BDN Staff

BANGOR, Maine — Since 2007, Eastern Maine Medical Center has been developing and refining its patient blood management program in a successful bid to decrease the need for blood transfusions. This week, medical experts from Western Australia are in Bangor, taking notes on how to implement a similar program at hospitals there.

“The world is about to change from blood transfusion to patient blood management,” said Axel Hofmann, a consultant for the Western Australia Department of Health, and EMMC is “almost at the center of the patient blood management universe.”

Hofmann is traveling with Julie Tovey, a clinical nurse consultant for the 450-bed Fremantle Hospital in the capital city of Perth, which will be the first of four public hospitals in Western Australia to implement a full-blown blood management program built on EMMC’s model.

Blood transfusions have long been considered the standard of care for patients who are anemic due to underlying health conditions such as cancer or who have lost blood during surgical procedures or physical trauma. But Hofmann said that’s an unfounded medical assumption that’s no longer supportable, and he listed several reasons why.

For one thing, he said, the demand for donated blood already far outstrips the supply, and that imbalance will only get worse as the baby boom generation ages. In addition, the cost of blood is “enormous,” he said. Although blood is donated by willing volunteers, it is increasingly expensive to test, process, store, transport and transfuse.

Giving patients blood also is inherently risky medically. Despite all the testing and other safeguards, a transfusion of blood can transmit viral diseases as well as set the stage for deadly blood clots, heart attacks, strokes, lung damage, kidney failure and other dangerous and costly complications.

Finally, Hofmann said, although it seems intuitive that receiving an infusion of blood would effectively counter anemia and boost the oxygen available to body tissues, “the efficacy … is not proven.” Like many widely accepted medical protocols, blood transfusion is driven more by professional habit than by scientific evidence, he said.

“It’s been grandfathered into the system and passed on to younger generations of doctors,” he said.

Dr. Irwin Gross, who heads up EMMC’s blood management program, said anemia often can be avoided or effectively treated with iron, hormones, vitamins and other means. During surgical procedures, lost blood can be collected, cleaned and returned to the patient. And emerging evidence shows that patients often tolerate anemia better than expected, he said.

EMMC’s state-of-the-art blood management program has succeeded in dramatically reducing the demand for donated blood, he said.

“Nationally, one third of patients undergoing knee or hip replacement undergo transfusion,” he said. “When we started our blood management program in 2007, we were at about 25 percent, so we were already below the national average. But now, only 2 to 3 percent of those patients are transfused.”

Gross said there will always be a need for donated blood, especially in emergency situations. But using blood in controlled, nonemergency settings at EMMC is far less frequent than it was, he said, due to ongoing physician education and electronic ordering systems that force doctors to consider alternatives.

Tovey and Hofmann spent three days at a hospital in New Jersey before arriving in Bangor Monday afternoon. They’ll leave Thursday to spend a day at a hospital in Rhode Island before returning to Western Australia. All three facilities have something to contribute to their understanding of patient blood management, Hofmann said. But EMMC’s program and progress, he said, is unmatched anywhere else.

For information about blood management, visit the website of the Society for the Advancement of Blood Management.

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