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Healthcare Professionals / Progress Notes / Quality/Risk Management / Choosing Wisely: five things physicians should question about blood management

 
Choosing Wisely: five things physicians should question about blood management
1/9/2015

Dr. Susan Bator says physicians should avoid prescribing unnecessary blood transfusions and products.

From Dr. Susan M. Bator, LG Health pathologist

Deliver the right care at the right time.

That’s the goal of the American Board of Internal Medicine Foundation’s Choosing Wisely campaign.

Choosing Wisely aims to spark conversations between providers and patients. More than 60 participating organizations have created lists of “Things Physicians and Patients Should Question.”
 
These five suggestions come from the American Association of Blood Banks:

  1. Don’t transfuse more units of blood than absolutely necessary.

Lower the transfusion threshold and treat the patient, not just the numbers, to decrease mortality, cardiac events, re-bleeding and infections. Single-unit transfusions are recommended for patients who aren’t actively bleeding. Follow up with reassessment of whether additional blood products are needed.

  1. Don’t transfuse red blood cells for iron deficiency without hemodynamic instability.

Anemia management is in its infancy at LG Health. Transfusion, which has become a routine medical response, is a Band-Aid. Treating iron deficiency with oral or IV iron (Venofer) is safe and inexpensive.

  1. Don’t routinely use blood products to reverse warfarin.

In many cases, IV vitamin K can reverse warfarin in four to six hours. Use prothrombin complex concentrates or plasma only if a patient has serious bleeding or requires emergency surgery.

  1. Don’t perform serial blood counts on clinically stable patients.

Unnecessary blood tests are a significant contributor to hospital-based anemia, especially for ICU patients. Unbundling tests and writing one-time orders and no orders beyond 72 hours can help.

  1. Don’t transfuse O negative blood except to O negative patients and in emergencies for women of childbearing potential of unknown blood group.

O negative blood units are in chronic short supply, due in part to overutilization for patients of other blood types. Trauma patients who are men or women beyond childbearing age can safely receive O positive blood before a blood type is obtained.  Once the type is known, type-specific blood can be given.

 
For more information on Choosing Wisely, click here.

 
 

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