Blood Shortages Leave Doctors with No Acceptable Options — Only Solution Is More Blood Donors

by Eric Gehrie, M.D., executive medical director for the American Red Cross

Right now, the American Red Cross urges people to donate lifesaving blood to help overcome an emergency blood shortage — a situation so dire that our national blood supply dropped by more than 25% in July.

As a medical professional, I recognize the concept of a blood shortage can seem difficult to relate to, especially given all the miraculous medical advances that we have enjoyed as a society. It can be tempting to wonder if we truly need blood transfusions as much as we did in the past, or to question whether there may be alternatives to blood transfusion that could be pursued.

Yet the only feasible source of blood for transfusion is the arm of a generous blood donor — and today’s need for blood is as critical as ever.

Over the past 25 years, advances in transfusion medicine identified numerous clinical circumstances where restrictive red blood cell transfusion practices resulted in the same or better patient outcomes, as compared to historically accepted transfusion practices that were more permissive of transfusion. The first of these major studies was published in the New England Journal of Medicine in 1999 and showed that critically ill adults in medical intensive care units who were transfused less did just as well as those who were transfused more. Subsequent studies showed similar results in various clinical settings, including critically ill children , severe gastrointestinal bleeding , septic shock , traumatic brain injury , hip surgery and cardiac surgery .

This shift — to withhold transfusion until anemia becomes more pronounced — places an even greater emphasis on the availability of blood supplies. Because most transfusion prescriptions are for patients with relatively severe anemia, a blood shortage leaves doctors with no easy choices for withholding transfusion. Instead, they wrestle with a series of bad options — often facing the very real possibility that a patient could suffer due to a delayed transfusion.

Trauma?

One of the most important advances in trauma medicine is the recognition that providing blood early can help save lives by preventing the development of intractable bleeding or bleeding that is difficult to stop (the coagulopathy of trauma).

Compared to 20 years ago — when a trauma patient’s resuscitation would have typically started with saline and red blood cells after reaching the hospital — more recent trends have identified the importance of providing blood early in the emergency room or, if possible, in the ambulance or helicopter en route to the hospital.

As a result, trauma hospitals are now encouraged to store blood in the emergency room to avoid a transfusion delay that could worsen patient outcomes. But during a blood shortage, hospital blood banks are often forced to remove blood from the emergency room and other remote storage locations — leaving trauma surgeons and anesthesiologists to consider the possibility that the hospital could run out of blood.?

Childbirth??

When there’s an emergency like a hemorrhage from childbirth, the margin between life and death for mother and baby could easily be the availability of a blood transfusion. In fact, postpartum hemorrhage is a leading cause of maternal deaths in the United States, with rates disproportionately higher for under-represented communities. These crises can happen suddenly, regardless of whether a pregnancy has been complicated or not.

Places like California have made progress in saving lives, in no small part, by making sure that blood is readily available when a hemorrhage occurs. Still, when there’s not enough blood on the shelves to serve all patients, doctors must decide if what’s available can be used to sustain a mother and child.

Cancer?

When undergoing cancer treatment, patients become intimately aware of their vulnerabilities, and the need for blood and platelet transfusions to protect them. But when there’s a blood product shortage, their anxiety can deepen: Without a platelet transfusion, will I experience internal bleeding? Will that lead to a stroke?

That’s because patients with cancer are often counselled by their physicians that they need transfusions to avoid these complications. However, during a blood shortage, they could easily be sent home from clinic without a transfusion — being told that the available blood instead needs to be reserved for other patients in the operating room or intensive care unit.

What’s more, a blood transfusion can be the difference between walking or using a wheelchair. Although a person’s hemoglobin level may be high enough to safely send them home, it may be low enough that they are too exhausted to walk or use stairs.

?Donate Today?

The only solution to prevent such heart-wrenching decisions is to ensure a steady supply of blood. This can only be achieved if more healthy individuals roll up a sleeve and donate blood regularly. Every donation can mean the difference between life and death for someone in need, whether it's a trauma patient, a mother in labor or a cancer patient undergoing treatment.

In a world where medical science has made it clear just how vital and irreplaceable blood transfusions are, we must rise to the challenge. That’s why we at the American Red Cross are pressing so hard right now for blood donations to overcome this shortage — and ensure patients get the lifesaving treatment that they need.

You can help. Make an appointment to give blood or platelets now using the Red Cross Blood Donor App, visiting RedCrossBlood.org or calling 1-800-RED CROSS (1-800-733-2767).?