Blood Simple

By Charlie Miraglia

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Dr. Charlie Miraglia is the Chief Medical Officer at

In 1984, the Coen brothers’ first film, Blood Simple, was released. It was filled with double-cross, murder, guilt, fear and – most relevant to this discussion, in a way – attempts to conceal evidence. While this film is darkly humorous and full of delicious irony, there is nothing funny at all about blood utilization in this country and our need to get a better handle on the appropriate transfusion of this precious resource. Evidence, in the form of real time data about blood utilization that tells us where we’re going astray, is how we’re going to help solve this mystery.

In recent years, much has been written about the issue of waste in healthcare. Blood utilization is certainly on the top ten list when it comes to opportunities for improvement. Widely variable clinical practices with respect to ordering and managing transfusions exist in this country, due in part to the minimal training received by medical staff on evidence-based transfusion practices. In addition, until recently the availability of clean, accurate, and timely data to help guide decisions around transfusion was lacking.


While demand for blood will remain high in the U.S., the economic realities that exist in healthcare, as well as the difficulties in recruiting and retaining donors, will continue to drive the need for more critical thinking when considering transfusing a patient. In fact, blood is transfused every 2 or 3 seconds in this country, helping people survive trauma, cancer, and a whole host of other serious illnesses. Creating better evidence-based standards, with live data and dashboards to support efficiencies as well as best practices, will not only save lives but also save millions of dollars each year in the cost of blood products.

Keep in mind that blood is not just expensive – it can be dangerous as well. Odds of suffering from a transfusion-related adverse event are fairly high and include things like transfusion related acute lung injury (TRALI), circulatory overload, and a number of known (and unknown) infectious diseases. Accessible and actionable data at the time of blood product ordering goes a long way in minimizing the associated risks of transfusion and should be part of any approach to optimizing these practices.

There are a number of other factors that are critical for any blood management program to be successful. Evidence-based guidelines, as I’ve mentioned several times already, are crucial to the process, as is a collaborative approach between clinicians, laboratory specialists, and hospital executives. The creation of multi-disciplinary teams to help with education and clinical decision support, and real time interventions will also be key to any program’s success. Continuous monitoring and measuring of the improvement in patient outcomes, and the overall financial impact on the organization because of improved decision-making, will also help bolster support for these types of initiatives.

Technology and teamwork will go a long way in making healthcare more efficient, of a higher quality, and value-based. The U.S. should be leading the charge in this area with our wealth of experience, data and emerging technologies. Driving the waste out of an industry’s processes and practices is far from a new concept, but for some reason healthcare has lagged behind in adopting the necessary skills to do so. Now is a perfect time in our history to be a leader in transfusion medicine and healthcare overall. Carefully scrutinizing the evidence that’s now available to us should help solve some of these clinical mysteries – or at the very least keep us from straying too far off the path to better health!

What’s your opinion on blood utilization? Let me know on Twitter: @ccmiraglia!

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