Blood management programs may reduce unnecessary transfusion costs

Health systems may want to look at their blood management programs to reduce unnecessary and costly transfusions, new research presented at the American Society of Anesthesiologists annual meeting last month suggests.

Hospitals and health organizations like the Johns Hopkins Health System have developed blood management programs to “promote clear hospital transfusion guidelines,” according to the National Institutes of Health.

These programs use several methods to minimize blood loss during surgeries, which in turn reduce the number of costly blood transfusions. They have also saved the health system about $2.9 million in blood acquisition costs between 2012 and 2022, according to Johns Hopkins researchers.

“For every dollar we spent [on blood management programs], we’ve saved over $7 in return,” Steven Frank, the study’s lead author and professor of anesthesiology and critical care medicine at Johns Hopkins Medicine, told Healthcare Brew. “We never had a lot of extra blood, and if you can reduce unnecessary transfusions, you’ll have more blood available for those who really need it, like trauma victims.”

Depending on the age of the patient, transfusions of blood and other blood products occur in 3.5%–5.1% of all surgeries in US hospitals, according to a 2022 report from America’s Blood Centers and the Association for Blood Donor Professionals.

Johns Hopkins spends about $1 million each month on red blood cells, Frank said. But the cost savings from these programs go beyond blood acquisition costs, Justin Halls, clinical pathology professor and medical director of transfusion services at the University of Texas Medical Branch (UTMB Health), told Healthcare Brew.

“The real cost of a transfusion runs far deeper than the cost of a unit from our supplier,” Halls said.

The Johns Hopkins Health System, however, has identified cost savings and additional revenue from its blood management programs.

For over a decade, the Johns Hopkins Health System has run two blood management programs: the patient blood management clinical community program and the Center for Bloodless Medicine and Surgery. There are currently over 20 methods in place to reduce bleeding and the probability that a patient would need a transfusion, Frank said.

The system’s patient blood management clinical community program, which began in 2012, encourages “keeping the blood in the patient” during surgery by lowering blood pressure to decrease bleeding or by collecting blood with smaller tubes for lab testing. Keeping patients warm during surgery and avoiding hypothermia can also reduce blood loss, Frank said.

He added that some program guidelines to reduce bleeding are inexpensive, such as ensuring that the patient isn’t anemic prior to surgery.

“I like to say $5 worth of iron tablets is definitely worth it if you can avoid $500 worth of blood transfusions,” Frank said.

The Johns Hopkins’s Center for Bloodless Medicine and Surgery, another blood management initiative, treats patients who can’t receive donor blood, like Jehovah’s Witnesses. The center brings in about $5 million annually from the program, researchers found.

Next, Johns Hopkins is looking to reduce the use of expensive “yellow products” in blood, such as plasma, platelets, and cryoprecipitate (or cryo), Frank said. The health system spends about $1 million per month on platelets that have a shelf life of five days, he added.

“Most patient blood management programs focus on red blood cells first,” Frank said. “There’s a huge opportunity to focus on the yellow products [...] because you can save a lot of blood and money that way as well.”