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January 7, 2009

Blood utilization in the U.S. vs. other countries

I spent most of today at a conference to look at ways to improve blood utilization. This refers to efforts to reduce the rates of transfusion of blood products to patients for whom these products are ordered for a variety of reasons. In our case, we are one of the largest users of platelets in the country because of the active and large bone marrow transplant program.

There was a very good representation of physicians, nurses, laboratory staff, perfusionists, pharmacists, quality improvement staff and administration at the conference and there was a lot of enthusiasm about making changes that could reduce utilization while maintaining quality and patient safety. The external consultants, Strategic Healthcare Group from Indianapolis led by Dr. Tim Hannon, organized the discussion.

One of the interesting snippets of information that came out has to do with relative utilization of blood products in the U.S. vs. other countries. To quote from "The Bloody Truth", a listing of some talking points from Strategic Healthcare :

Blood utilization in the United States is significantly higher than in most Western countries and the gap is increasing. While blood utilization in the U.S. increased by 16% from 1999-2004, it decreased by 8% in the United Kingdom during the same period. Remarkably, blood utilization in the U.S. is currently 15% higher per capita than in Europe and 44% higher than in Canada. This difference is likely attributable to a combination of higher blood prices, national transfusion education progams, hemovigilance programs which spotlight transfusion risks, and accountability for performance and compliance at the hospital level.

Of course, the same could be said for many aspects of medical care in the United States. I see this as a manifestation of a "culture of abundance", which means that we enjoy vast resources, perhaps unparalleled in many other parts of the world. The question is do we always use these resources judiciously and prudently? Is more always better? When it comes to blood products, the answer is clearly, 'no'. There are risks associated with transfusion of blood, and the goal should be to transfuse what's needed for an individual patient, and no more.