A transfusion medicine physician in a Midwestern state asks "How does a facility become a "bloodless" hospital or surgery center? What are the criteria? Does any accreditation agency recognize that designation?"

The following comments have been received.

1. Dr. Aryeh Shander of Englewood Hospital & Medical Center in New Jersey (attribution used with permission) reports that no hospital can become totally 'bloodless', but can develop programs that minimize the need for blood transfusions by employing pharmacological, other options for blood management, and by optimizing the management of blood products (including the patient's autologous blood). To become a "bloodless" center requires planning and coordination by a hospital's administration and medical staff, as well as other healthcare providers who participate in the care of patient who become (or might become) anemic, thrombocytopenic, and/or coagulopathic. 'Criteria' are very loose and essentially address a set of policies and procedure for advanced directives, care of the incompetent patient, pediatric and obstetrical patient. Protocols for blood conservation (which are considered by many to be routine medical care) are usually developed by the specific institution desiring the title. Cardiac and vascular institutes are an example. Cardiac surgery is routine surgical treatment but is 'protocolized' and marketed as a "special care" entity. The Association of Blood Conservation (ABC) will accredit a hospital for a fee, but so far that organization has not been authorized to perform inspections on behalf of CMS or JCAHO). The Society for the Advancement of Blood Management (SABM) is a professional organization whose Core Purpose is to improve patient outcomes through optimal blood management. Finally, there are commercial companies that (for a fee) can assist a hospital in setting up a "bloodless" program.

ADDENDA Oct. 28, 2005

2. A transfusion medicine physician in Northern California suggests that colleagues read the article in Transfusion (Volume 43 Issue 5 Page 668- May 2003) entitled Bloodless medicine: clinical care without allogeneic blood transfusion by Lawrence T. Goodnough, Aryeh Shander, and Richard Spence.

3. A colleague reports that a Bloodless Hospital Database can be found at http://www.sabm.org/hospitals/.

ADDENDA Oct. 31, 2005

4. The communications committee of the Society for the Advancement of Blood Management (SABM) is in the process of defining criteria for being listed on the SABM website as a "bloodless" program and would appreciate receiving any suggestions as to the criteria that colleagues deem appropriate to qualify as a "bloodless" program. Suggestions may be directed to Dr. Jonathan Waters at watejh@anes.upmc.edu.

ADDENDA Nov. 7, 2005

5. Karen Scalici (attribution used with permission), Chair of the Standards Committee for the Association for Blood Conservation (ABC), reports that the ABC (formerly the National Association for Bloodless Medicine and Surgery (NABMS)) has Administration and Practice Standards for Bloodless/Blood Conservation programs. She writes that "There are eight standards for developing and implementing new formal programs as well as evaluating existing programs. The standards are functionally organized and present general guidelines and recommendations based upon objective criteria regarding coordination of the bloodless program with other healthcare team members. The standards focus on continuity of care with methods to evaluate quality, appropriateness and effectiveness of the bloodless program services and other related services necessary for delivery of bloodless healthcare to the highest level of compliance possible. The standards assist when devleoping new programs to assure all the necessary elements are addressed. The standards then demonstrate to the hospital, its staff and the public it serves, through the accreditation process, that the Bloodless/Blood Conservation program has met all the criteria and is a safe and effective program that the consumer can put their trust in."

6. A transfusion medicine physician in New York suggests that the "bloodless" program standards should include a requirement that each facility offering such programs for reducing blood use to patients should employ an 'ethics' review of how their patients are informed of the programs. He adds that patients should be informed of the available scientific evidence, whether or not that evidence is retrospective or randomized, and that undergoing surgery in extreme anemia may increase the perioperative morbidity beyond any associated risk of transfusion.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator