A recent study from The Center for Bloodless Medicine and Surgery at Johns Hopkins Hospital demonstrated that patients who declined transfusions and were managed by blood conservation suffered fewer deaths, infections and other morbidities compared to patients who were transfused (Clinical Anesthesiology, November 2014, volume 40:11).

The study included 294 patients who refused blood transfusion and 1157 patients with closely match backgrounds that received transfusion during either surgery or medical care between June 2012 and August 2013. Medical patients included patients with cancer and gastrointestinal bleeding. Discharge hemoglobin levels averaged 10.8 for both groups of patients.

Blood-conservation methods included the diagnosis and treatment of anemia before hospitalization, reduction of intraoperative blood loss, inpatient treatment with IV iron and erythropoietin. Autologous blood salvage was utilized during surgery.

Mortality rates were 2.7% for patients receiving transfusion and 0.7% in patients managed with blood conservation methods. Rates of infection and thrombosis also trended lower in the non-transfused patients.

Total and direct hospital costs were12% and 18% lower, respectively, in the non-transfused group. The savings were most pronounced in surgical patients. The average total charge for bloodless patients was $25,568 compared to $30,162 for transfused patients. Hospital lengths of stay were roughly the same for the bloodless patients and those in the control group.

Paul M. Ness, MD, director of the Division of Transfusion Medicine at Johns Hopkins Hospital, said advocates for bloodless medicine too often rely on anecdotal evidence to make their point. By contrast, this study offers a comprehensive, data-intensive look at the issue.

Although the number of patients undergoing bloodless therapy as small, this controlled study clearly demonstrated the medical and financial benefits of a comprehensive blood management program. 


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