Overstocked blood drains nations supply

DALLAS, April 5 Outdated hospital blood ordering policies that require five times more blood than is necessary for cerebrovascular surgery may be adding to the drain on the nations blood supply, according to a report in todays Stroke: Journal of the American Heart Association. Researchers say it may be time for hospitals to change their policies to reflect surgical advances that require less blood.

Researchers conducted a study to determine how much blood is really used compared to what is reserved for major types of brain vessel surgeries, including carotid endarterectomy (surgery to clear blocked neck arteries) and aneurysm repair.

Before blood can be used in surgery, it must undergo several tests to ensure it is compatible with the patients blood. These tests include ABO and Rh typing (to determine blood type), an antibody screen and a cross-match. In a cross-match, the patients red blood cells (RBCs) are mixed with those of commercially purchased RBCs that express all the common clinically significant antigens.

At many institutions, there are policies about how RBCs are ordered for vascular neurosurgery, but these policies vary widely, says primary researcher Neal F. Kassell, M.D., department of neurosurgery, University of Virginia Health System, Charlottesville. The policy is often based on tradition rather than a formal audit of the facilitys transfusion practices. The number of units of RBCs prepared in advance for surgery is always greater than the number of units actually transfused.

While the percentage of blood that is reserved but never used varies by institution, its high enough and the cost is high enough that researchers recommend that each institution update its policy according to its current blood usage.

Because of modern advances, we are using less blood than we used to, particularly in surgery, says Kassell. Changing blood-use policies can decrease costs and make better use of this scarce and important resour

Contact: Carole Bullock
American Heart Association

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