• July 23, 2014

Temple doctor explains why the demand has decreased

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Posted: Monday, October 21, 2013 4:30 am

TEMPLE — As demand for blood decreases, staffing at community blood banks is dropping.

There’s no indication that staffing at Scott & White Blood Center will be cut, considering Scott & White Hospital System has to rely on the American Red Cross, its secondary supplier, to meet the health care system’s blood needs, said Dr. Walter Linz, pathologist and medical director of Scott & White blood bank and transfusion medicine.

“I collect blood so I don’t want to discourage that,” Linz said. “I still can’t collect quite enough that’s needed by the institution, so it isn’t as if I don’t know what to do with the blood I have.”

The decrease in need for blood is a great thing and the result of a number of factors, Linz said.

Research has shown that in many cases, less is more when it comes to blood transfusion.

“It turns out getting people close to normal levels isn’t necessary and may be harmful,” he said.

One study looked at patients in intensive care units. Those individuals fared better when they received less blood.

Another study showed that patients with gastrointestinal bleeding do much better when given less blood.

Blood is good when it’s absolutely needed, Linz said; however, there are more risks associated with it than was previously thought.

“The infectious disease risk is under control,” he said. “Blood is a living product and when you give this thing, you’re affecting someone’s immune system.”

Improved technology

There’s also improved technology that gives surgeons and clinicians information that can be used to make better decisions about blood needs, Linz said.

A couple of years ago, thromboelastography — which measures the efficiency of a patient’s clotting — was brought into the transfusion service at Scott & White. The information it provides is now available in real time during surgery.

“Our anesthesiologists are very good at reading those and knowing exactly what, if any, blood product to give,” Linz said.

Not long ago, when a cardiac thoracic patient was bleeding during surgery, everything from red blood cells to platelets was used to stop the bleeding.

Now, they can determine if it’s a blood problem or there’s a small vessel bleeding that hasn’t been found, he said.

The technology was developed in Germany in the late 1940s for research purposes. In the 1990s, people began looking at the best way to determine what a bleeding transplant patient needs — red cells or platelets.

As it turns out, over time prospective transplant patients’ bodies develop blood factors that dissolve clots, which becomes a problem when a new organ is transplanted. “The solution is never more blood or blood products, but medication,” Linz said.

The technology is not expensive, and it’s driven a lot of costs out of the health care system, including the purchase and delivery of the product and minimizing bad outcomes associated with transfusions.

“I can’t think of too much else in health care in the last couple of years that has driven down costs and driven up quality in a way this has,” he said.

With the need for blood becoming fine-tuned, the demand for blood products is down. There’s been a 30 percent drop in blood utilization in the last 18 months at Scott & White, plus the number of people receiving blood has decreased.

The Scott & White Blood Center provides blood to Scott & White, McLane Children’s, Round Rock, College Station and Taylor. Blood is also provided to the Continuing Care Hospital, Santa Fe Hospital and to the clinics.

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