In an international comparison, Germany is downright wasteful of the valuable resource of blood. According to data from 2017, 3.2 million units of blood were used nationwide, more than 240,000 of which were used in Hesse. Consumption in Hesse was 38.9 units per 1000 inhabitants. For comparison: In the Netherlands, consumption was 23.8 units per 1000 inhabitants. Blood is also expensive: in Hesse alone, transfusions cost more than 35 million euros in 2017.
Kai Zacharowski, Director of the Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy at the Frankfurt University Hospital, is convinced that many a bag could be saved during an operation if the preparation before planned interventions were only improved. The so-called patient blood management was introduced at the university hospital ten years ago. Now the Barmer health insurance company has been the first to include this service for the members in its range of care in order to increase patient safety, as Martin Till, State Manager of Barmer in Hesse, announced. For example, the treatment of anemia, also known as anemia, before a planned operation is to be financed.
Women are more at risk
Because anemia can lead to a lack of oxygen in the body because hemoglobin, the oxygen transporter, is missing in the blood. According to the World Health Organization, women already have anemia if their hemoglobin level is below 12 grams per deciliter, and men are defined as 13 g/dl. In the event of blood loss during an operation, the patient’s hemoglobin level drops – a critical threshold above which a transfusion is indicated is then reached more quickly in women than in men. To compensate for this, Zacharowski and his colleagues have made it standard at the university clinic that men and women must have a hemoglobin value of more than 13 g/dl before an operation.
In about a third of cases, anemia is due to iron deficiency, explains the doctor. If you have a lot of patience, you can balance your iron stores over months by changing your diet or taking pills, which are not always well tolerated. A syringe also helps in the quick process. The latter is even possible the day before the procedure, says the intensive care doctor.
Patients must request clarification
Zacharowski is passionate about this topic, because better preparation for operations can not only prevent unnecessary transfusions and their possible side effects, but the clarification of anemia before a planned operation can also statistically significantly reduce the risk of death. He is particularly concerned with educating patients so that they can take an interest in their hemoglobin level before an operation: “You must ask for this level to be clarified before an operation.”
Since 2013, Patient Blood Management has been coordinated at the University Hospital Frankfurt by the Clinic for Intensive Care Medicine and the Institute for Transfusion Medicine of the DRK blood donation service. However, it is not only aimed at the preoperative treatment of iron deficiency. Blood-saving surgical techniques, the collection, processing and return of wound blood using a special device, the cell saver, are also used there. In addition, when taking blood for laboratory analysis, special narrower tubes are used that can be filled with less blood. The optimized use of foreign blood transfusions is also part of the concept. “Thanks to many preventive measures, we can ensure that all of our patients who need a blood transfusion receive it,” says Zacharowski.
Johanna Dürrholz Published/Updated: Recommendations: 2 Lucia Schmidt Published/Updated: Recommendations: 34
Patient blood management has been required by the World Health Organization since 2011, but so far only about 300 out of 2000 clinics in Germany have integrated it into their processes. According to Zacharowski, only about 40 clinics implement the “gold standard” of blood management with about 100 individual measures, in Hesse there are a maximum of eight. The physician is convinced that the previous willingness to donate blood would be completely sufficient to cover the need if patient blood management were to be introduced across the board.