Issue 2 • 2022
© 2022 The Royal Australasian College of Physicians

New recommendations to prevent overuse of blood transfusions

The RACP’s Evolve initiative recently launched a major set of recommendations on the use of blood transfusions in the healthcare system.
Evolve is a flagship initiative that aims to reduce low-value care by supporting physicians to be leaders in changing clinical behaviour for better patient care, make better decisions, and make better use of resources.
The new recommendations, developed by the Australian and New Zealand Society of Blood Transfusion (ANZSBT), were launched in March and featured as a major online ABC News exclusive. RACP Lead Fellow, and Vice President of the ANZSBT Dr Anastazia Keegan, told media outlets that “Blood transfusions can be lifesaving– however we are still seeing a reliance on blood and blood products in circumstances where it has been proven to be unnecessary.”
“Blood transfusion doesn’t come without risks to patients. Most transfusion reactions are transient and easily managed such as febrile reactions, allergic reactions and transfusion-associated circulatory overload. However, some reactions are life-threatening such as acute haemolytic reactions, transfusion-transmitted infections, transfusion-associated acute lung injury and anaphylaxis.”
“Blood is a scarce and precious resource so physicians need to use it wisely.”
The new evidence-based recommendations align with the blood management standard, one of the eight National Safety and Quality Health Service (NSQHS) Standards developed to protect Australians from harm and to improve the quality of health service provision. The new Evolve recommendations ask physicians to:
  1. Not to use peri-operative transfusion for otherwise reversible anaemia prior to elective surgery
  2. Not to transfuse red blood cells for iron deficiency where there is no haemodynamic instability
  3. Not to transfuse more units of blood than necessary
  4. Not to order a group and crossmatch when a group and antibody screen would be appropriate
  5. Not to transfuse standard doses of fresh frozen plasma to correct a mildly elevated (<1.8) international normalised ratio prior to procedure.
Part of a global movement, Evolve is a flagship initiative led by physicians, specialties and the Royal Australasian College of Physicians (RACP) to drive high-value, high-quality care in Australia and New Zealand. RACP is a founding member of Choosing Wisely in Australia and New Zealand, with all Evolve recommendations becoming part of the Choosing Wisely Australia campaign.
Find out more about the recommendations on the Evolve website.