Breaking News
November 18, 2018 - Rainforest vine compound makes pancreatic cancer cells susceptible to nutrient starvation
November 18, 2018 - A new mechanism in the control of inflammation
November 18, 2018 - Age-related decline in abstract reasoning ability predicts depressive symptoms over time
November 18, 2018 - Scientists succeed in increasing stability, biocompatibility of light-transducing nanoparticles
November 18, 2018 - Sugar, a ‘sweet’ tool to understand brain injuries
November 18, 2018 - Pharmacist-Led Effort Cuts Inappropriate Rx in Older Adults
November 18, 2018 - Novel discovery could lead to new cancer, autoimmune disease therapy
November 18, 2018 - AHA and ADA launch new initiative to help people with type 2 diabetes reduce heart disease risk
November 18, 2018 - Balanced production of pro and anti-inflammatory cytokines at two years of age protects against malaria
November 18, 2018 - New pharmacological agent shows promise for prevention of heart rhythm disorders
November 18, 2018 - All That Social Media May Boost Loneliness, Not Banish It
November 18, 2018 - Scientists shine new light on link between obesity and cancer
November 18, 2018 - Risk factors for cardiovascular disease closely track with changes in diet patterns
November 18, 2018 - Biogen Scoops Sixth Prix Galien Award with UK Win for Life-Changing Rare Disease Medicine
November 18, 2018 - Detectable HIV-1 in treated human liver cells found to be inert
November 18, 2018 - Using light to control crucial step in embryonic development
November 18, 2018 - Unusual case of father-to-son HIV transmission reported
November 18, 2018 - FDA Approves Aemcolo (rifamycin) to Treat Travelers’ Diarrhea
November 18, 2018 - Poverty blamed on widening north-south gap in young adult deaths in England
November 18, 2018 - Progress in meningitis lags far behind other vaccine-preventable diseases, analysis shows
November 18, 2018 - Consensus Statement Issued on Management of Foot, Ankle Gout
November 18, 2018 - Fine particle air pollution is a public health emergency hiding in plain sight
November 18, 2018 - In-hospital mortality higher among patients with drug-resistant infections
November 17, 2018 - Research shines new, explanatory light on link between obesity and cancer
November 17, 2018 - FIND explores new diagnostic assays for confirmatory HCV diagnosis in community settings
November 17, 2018 - Tracking Preemies’ Head Size May Yield IQ Clues
November 17, 2018 - Scientists call for unified standards in 3-D genome and epigenetic data
November 17, 2018 - Lab Innovations 2018 has beaten all records by attracting 3,113 attendees
November 17, 2018 - New strategy to hinder emergence of antimicrobial-resistant pathogens
November 17, 2018 - Sexuality education before age 18 may reduce risk of sexual assault in college
November 17, 2018 - Reducing cellular proliferation could help deplete HIV reservoir and lead to a functional cure
November 17, 2018 - New model of FSHD could be useful to study effectiveness of experimental therapeutics
November 17, 2018 - FDA approves antibacterial drug to treat travelers’ diarrhea
November 17, 2018 - Lab Innovations 2018 confirmed as a major hit with visitors, exhibitors and speakers
November 17, 2018 - Largest parasitic worm genetic study hatches novel treatment possibilities
November 17, 2018 - UCLA biologists uncover how head injuries can lead to serious brain disorders
November 17, 2018 - Static and dynamic physical activities offer varying protection against heart disease
November 17, 2018 - Obesity significantly increases risk of Type 2 diabetes and coronary artery disease
November 17, 2018 - New method to analyze cell membrane complexes could revolutionize the way we study diseases
November 17, 2018 - Researchers show how proteins interact in hypoxic conditions to facilitate mitochondrial fission
November 17, 2018 - People with rare cancers can benefit from genomic profiling, shows research
November 17, 2018 - NIH awards over $1.8 million to husband-and-wife doctors to test new breast cancer approach
November 17, 2018 - Four-in-one antibody used to fight flu shows promise in mice
November 17, 2018 - New approach allows pathogens to be starved by blocking important enzymes
November 17, 2018 - Higher body mass index could cause depression even without health problems
November 17, 2018 - Protein which plays role in sensing cell damage serves as new target to treat pulmonary hypertension
November 17, 2018 - FDA Approves Adcetris (brentuximab vedotin) in Combination with Chemotherapy for Adults with Previously Untreated Systemic Anaplastic Large Cell Lymphoma or Other CD30-Expressing Peripheral T-Cell Lymphomas
November 17, 2018 - ID specialist input improves outcomes for outpatient parenteral antimicrobial therapy
November 17, 2018 - UT Southwestern scientists selected to receive 2019 Edith and Peter O’Donnell Awards
November 17, 2018 - New clinical algorithm to help individuals manage type 2 diabetes when fasting during Ramadan
November 17, 2018 - Researchers identify LZTR1 as evolutionarily conserved component of RAS pathway
November 17, 2018 - Heart Disease Leading Cause of Death in Low-Income Counties
November 17, 2018 - Estrogen Levels Test: MedlinePlus Lab Test Information
November 17, 2018 - Research reveals link between immunity, diabetes
November 17, 2018 - Research shows how to achieve improved smoking cessation outcomes within California’s Medicaid population
November 17, 2018 - New study finds less understanding and implementation of patient engagement
November 17, 2018 - New shoe insole technology could help diabetic ulcers heal better while walking
November 17, 2018 - New method to extend cell division and immortalization of avian-derived cells
November 17, 2018 - Australian Academy of Science urges parents to vaccinate children against meningococcal disease
November 17, 2018 - Hot water treatment may help improve inflammation and metabolism in sedentary people
November 17, 2018 - Researchers produce 3D chemical maps of small biological samples
November 17, 2018 - Must Blood Pressure Rise Wth Age? Remote Tribes Hold Clues
November 17, 2018 - Noonan Syndrome
November 17, 2018 - Interventions to delay and prevent type 2 diabetes are underused, researchers say
November 17, 2018 - Hackathon prize winner seeks to remotely monitor patient skin conditions
November 17, 2018 - Research team identifies Ashkenazi Jewish founder mutation for Leigh syndrome
November 17, 2018 - Gene editing could be used to halt kidney disease in patients with Joubert syndrome
November 17, 2018 - Study uncovers link between gut disruption and aging
November 17, 2018 - Teens more likely to pick up smoking after exposure from friends and family
November 17, 2018 - Nicoya designate the Institute for Stem Cell Biology and Regenerative Medicine as the OpenSPR Centre of Excellence
November 17, 2018 - new horizon in dental, oral and craniofacial research
November 17, 2018 - How does poor air quality affect your health?
November 17, 2018 - New device can regulate children’s blood glucose more like natural pancreas
November 17, 2018 - Game-Changers in Western Blotting and Protein Analysis
November 17, 2018 - FDA announces new actions to limit sale of e-cigarettes to youth
November 17, 2018 - Warmer winter temperatures related to higher crime rates
November 17, 2018 - MCO places increasing emphasis on helping people find and access healthy food
November 17, 2018 - Group of students aim to improve malaria diagnosis using old smartphones
November 17, 2018 - Transplantation of feces may protect preterm children from deadly bowel disease
November 17, 2018 - Researchers explore whether low-gluten diets can be recommended for people without allergies
Blood management program associated with fewer transfusions in orthopedic patients

Blood management program associated with fewer transfusions in orthopedic patients

image_pdfDownload PDFimage_print

A patient blood management program designed to limit the amount of transfused blood orthopedic patients undergoing common surgeries such as hip and knee replacement receive was associated with fewer transfusions, reduced blood use and improved outcomes, reports a study published in the Online First edition of Anesthesiology, the peer-reviewed journal of the American Society of Anesthesiologists (ASA).

“A growing body of literature shows reducing blood use in surgery reduces risks to patients while also lowering costs,” said lead author Steven M. Frank, M.D., director of the Johns Hopkins Health System Blood Management Program. “However, there is a persistent impression that orthopedic surgery patients require a higher hemoglobin transfusion threshold than other patient populations.”

The AABB (formerly the American Association of Blood Banks) guidelines call for most patients to be given a blood transfusion when their hemoglobin level drops to 7 grams per deciliter (g/dL) of blood. But for orthopedic and cardiac surgery patients, the guidelines call for giving a blood transfusion when their level drops to 8 g/dL.

“It may seem like a small difference, but before our blood management program was implemented, one third of blood used in our hospital was transfused at levels between 7 and 8 g/dL, so a lot of blood was given in that intermediate zone,” Dr. Frank said. “A substantial number of transfusions could potentially be avoided by lowering the threshold to 7 g/dL.”

Possible risks and adverse outcomes associated with blood transfusions include acute lung injury; transfusion associated circulatory overload (TACO), which causes excess fluid in the lungs; hemolytic (rupture of red blood cells) transfusion reactions, which most often occur from wrong or incompatible blood units being given; and infectious or viral transmissions.

In the study, researchers evaluated blood transfusion practices and clinical outcomes in all adult orthopedic patients over a four-year period, which covered the time in which the hospital implemented its blood management program. The study included 1,507 patients before the program was implemented and 2,402 after implementation.

The blood management program consisted of 10 strategies to reduce transfusions, including only administering a single unit of blood unless the patient was actively hemorrhaging, administering the drug tranexamic acid during surgery to reduce bleeding, maintaining normal body temperature during surgery to reduce bleeding, adding pop-up alerts in patient electronic medical records to notify clinicians when the amount of blood ordered for a transfusion was above recommended levels, guideline compliance audits with provider feedback, smaller tubes to reduce blood loss from lab tests, and using newer surgical techniques to reduce bleeding.

After the blood management program was implemented, the percentage of orthopedic surgery patients who received blood transfusions decreased from 16.1 percent to 9.4 percent. The average hemoglobin threshold used to trigger a transfusion decreased from 7.8 g/dL to 6.8 g/dL. Overall blood use during transfusions decreased by 32.5 percent. In hospital-acquired complications fell from 1.3 percent to 0.54 percent, and 30-day readmissions fell from 9 percent to 5.8 percent. Improved outcomes were primarily recognized in patients 65 years of age or older.

“We found that in orthopedic patients, even with a lower hemoglobin trigger of 7 g/dL for blood transfusions, patients did as well or better than they did with a higher hemoglobin trigger level,” Dr. Frank said. “This is the first study to show that for most orthopedic patients-;even elderly patients-;a hemoglobin level of 7 g/dL appears to be safe.”

Dr. Frank said while the study does suggest that most orthopedic patients could be transfused at a hemoglobin level of 7 g/dL instead of 8 g/dL, this was not a randomized clinical trial. “A trial formally assessing this lower hemoglobin trigger should be conducted before guidelines are changed to recommend a level of 7 g/dL for all orthopedic patients,” he said. “Furthermore, we treat the whole patient, not just their lab values, so signs and symptoms of anemia should also be considered.”

Blood transfusions were named the most frequently performed hospital procedure in the United States and one of the top five overused procedures by the Joint Commission in 2012.​​

Source:

http://www.asahq.org/about-asa/newsroom/news-releases/2018/08/blood-management-program-safely-reduces-transfusions-in-orthopedic-patients

Tagged with:

About author

Related Articles