Blood Management toolkit

Why Focus on Blood Management?

Due to critical blood shortages across the country, the American Red Cross recently made substantial changes in blood availability to all hospitals, including McLaren. These changes could threaten our ability to fulfill RBC orders in the coming weeks and months, as the nationwide blood product shortage is likely to continue indefinitely. McLaren is taking proactive steps to mitigate against the possibility of running dangerously low on in-house RBC units, which could lead to canceling some elective surgeries and/ or diverting trauma patients. Key among these steps is reinforcing and monitoring existing transfusion guidelines approved by the High Value Care team in 2018:

• For hemodynamically stable, normovolemic inpatients and outpatients, the hemoglobin level indication for transfusion is < 7.0 g/dL, although patients with active cardiac symptoms may require a threshold of 7.5- 8.0 g/dL.

• All stable patients without significant bleeding should be transfused a single unit of RBCs then reassessed: “Why Give Two When One Will Do.”

• Blood management toolkit resources are now available on this website.

• Daily blood inventory across the Subsidiaries will be reported to the CMOs.

We anticipate that these changes should not negatively impact the ability to provide quality patient care or negatively impact patient outcomes, and can potentially preserve our ability to care for emergent trauma patients without depleting our supply of RBC units. Please continue to exercise good stewardship and follow the updated transfusion guidelines during this difficult time when ordering blood products, and we will provide further updates as they become available.

Choosing Wisely Lists Supporting Blood Management

Canadian Society of Transfusion Medicine

Ten things physicians and patients should question about blood transfusion.

American Association of Blood Banks

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

Critical Care Societies Collaborative – Critical Care

Don’t transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 g/dL.

American Society of Anesthesiologists

Don’t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ≥6 g/dL unless symptomatic or hemodynamically unstable.

American Academy of Family Physicians

Don’t transfuse more than the minimum of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable patients).

American Society of Hematology

Don’t transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac in-patients).

Society for the Advancement of Patient Blood Management

Don’t proceed with elective surgery in patients with anemia until properly diagnosed and treated.

American Society of Hematology-American Society of Pediatric Hematology/Oncology

Don’t transfuse platelets in an asymptomatic (i.e., non-bleeding) pediatric patient with hypoproliferative thrombocytopenia (e.g. aplastic anemia, leukemia, etc.), with a platelet count > 10,000/mcL who is at least one year old, unless signs and/or symptoms for bleeding develop, or if the patient is to undergo an invasive procedure.

Society for the Advancement of Patient Blood Management

Don’t transfuse plasma in the absence of active bleeding or significant clinical and laboratory evidence of coagulopathy.