Changing the paradigm for transfusing the anemic patient in an acute care environment.

Blood is a precious and vital resource in medicine. Its importance in maintaining human life is second only to the oxygen it transports. Nearly 300,000 blood product transfusions occurred in Kentucky last year. While donor attrition from the pool is inevitable, recruiting efforts have resulted in an overall stable donor population in the state over the last five years. Roughly 5% of community members who are eligible to donate do so each year. Despite our effort to constantly recruit new donors, there is evidence to suggest that clinicians are less than rigorous in their efforts to conserve and to be accountable for this precious human product. For example, the indications for blood transfusions are often not documented in up to a third of the cases, and arbitrary transfusion "triggers" are often the criteria used to justify transfusion rather than the patient's clinical condition. Recent development of evidence-based criteria for prevention and treatment of anemia combined with technological advances suggest that a major paradigm shift in the clinical use of red cells is warranted.