Transfusion demand control strategies: Potential efficacy of hospital and regional interventions.

In their manuscript, Crispin et al. analyse different strategies (“contingency plans”) to effectively decrease transfusion demand in periods of 1)acute or longer lasting shortfall of the allogeneic blood supply (e.g. seasonal or pandemic infections of the donor pool with known or unknown pathogens, interruptions of the supply chain) or 2)a sudden increase of blood demand (natural or man-made disasters). The analysis is based on a retrospective review of 2305allogeneic transfusions performed in the Canberra region of Australia between March and September 2003.
Transfusion demand could be effectively reduced 1)by 17.3% by avoiding transfusion for inappropriate indication, and 2)by 9% by cancelling elective surgery with high estimated blood losses. If elective surgery deferral was adopted as a strategy only after eliminating inappropriate transfusions, it could reduce the red cell usage by a further 5.5%. There were significant differences between hospitals and departments (highest blood usage in hematology, orthopedics and gastroenterology departments). The effect of other common blood conservation techniques (e.g. cell salvage, deliberate hypotension, etc.) was not investigated. The study also did not determine for how long transfusion could be deferred using the proposed strategies.

In conclusion, optimizing transfusion practice and cancelling elective high blood loss surgery are effective strategies to acutely reduce allogneic blood demand in situations of a shortfall of blood supply.

– Oliver Habler