Anemia - Blood Conservation

Running head: CHANGE: BLOOD CONSERVATION

Change: Blood Conservation

Table of Contents

Lewin's Theory..................................................................................................4

Identification of the Problem.................................................................................

Research Articles..............................................................................................

Proposed Solution..............................................................................................

Moving Forces..................................................................................................

Restraining Forces.............................................................................................

Plan for Integrating Care......................................................................................

Refreezing.......................................................................................................

Conclusion.......................................................................................................

References.......................................................................................................

Appendix A: Research Articles...............................................................................

Lewin's Theory

Identification of problem

Anemia is defined as a decrease in the number of red blood cells (RBC) leading to the tissues being insufficiently oxygenated (Sole, Klein, & Moseley, 2005). In the United States, anemia has become a significant issue affecting approximately 3.4 million people (Spence, 2007). Hospitalizations contribute greatly to the cause of many Americans developing anemia. Within three days of admission to an intensive care unit (ICU), 95% of patients become anemic from the amount and frequency of blood withdrawn for laboratory analysis (Corwin, 2003).

Research on the topic of anemia has concluded that 1.5 to 10 mL is withdrawn for arterial blood gases (ABG) and approximately 4 to 10 mL for coagulation studies, hematology, and chemistry samples (Fowler & Berenson, 2003). On average, the amount of blood drawn daily from a patient in the ICU is 41 milliliters (mL) (Corwin, 2003). Approximately 100 mL of phlebotomy results in a decrease of 0.70 grams per deciliter (g/dl) in hemoglobin (Hgb) and decrease of 1.9 percent (%) in hematocrit (Spence, 2007). The normal bone marrow can replace approximately 50 mL of blood everyday; however, during periods of stress or illness the bone marrow is unable to replenish the RBC supply as quickly as it could in a healthy individual (Woodhouse, 2001). The amount of blood being discarded from central lines (approximately 10 mL) prior to blood withdraws is a large contributor to the development of iatrogenic anemia (Earley, Gracias, Haut, 2006).

Within the ICU, the mean range of blood withdrawals is between five and 24 samples daily. In the ICU and other critical care areas there is a standard panel of labs drawn daily from each patient, without regard to the labs that each individual patient requires. Patients with in-dwelling arterial lines are subject to three times the amount of blood withdraws than those without due to the ease of phlebotomy (Fowler & Berenson, 2003).

The primary treatment for anemia has been an allogeneic blood transfusion; however, there have been multiple risks associated with blood transfusions affecting morbidity and mortality. An acute hemolytic transfusion reaction occurs once in every 25,000 units of blood infused. This reaction has life-threatening consequences mainly due to incompatible blood being administered to patients. Fever and hypotension could result after only 0.7 mL being administered, and death could occur after approximately 30 mL (Spence, 2007). A delayed hemolytic transfusion reaction occurs once in every 2, 500 units. This reaction is initially unnoticed and could occur up to two weeks after the transfusion occurred. Fever, jaundice, and anemia result from the antibody-coated erythrocyte being cleared by the body (Spence, 2007). "According to the National Institute of Health, as many as 1 in 12,000 units of blood are given to the wrong patient, resulting in at least 10 fatal hemolytic reactions per year" (Corwin, 2003, p. 20).

Transfusion-related acute lung injury (TRALI) occurs once in every 10,000 units. This reaction is the third leading cause of death related to transfusions and it results from the antibodies from the blood donor reacting to the leukocytes in the blood recipient. Within six hours, bronchospasm, hypoxia, fever, and diffuse bilateral pulmonary infiltrates may occur, which could lead to respiratory arrest. Anaphylactic reactions occur once in every 150,000 units. Although rare, signs and symptoms develop within minutes of beginning the transfusion, and include hypertension, flushing, bronchospasm, swelling of the throat, and chills (Spence, 2007). Human immunodeficiency virus (HIV) use to be the primary concern when receiving a blood transfusion, but current techniques to clean and test the blood have caused this to be reduced to a very rare concern, only one per 1.8 million units may be infected (Corwin, 2003).

Another consequence of blood transfusions is immunosuppression and the risk for nosocomial infections. Transfusion of each unit of packed red blood cells (PRBC) increases the risk of developing a nosocomial infection by a factor of 1.5 (Spence, 2007). It is necessary to attempt to prevent nosocomial infections because insurance companies are not reimbursing hospitals for the costs of treatment and analysis of the infection.

Research

In 2006, A.S. Early, V.H. Gracias, E. Haut, C.P. Sicoutris, D.J. Wiebe, P.M. Reilly, and C.W. Schwab wrote Anemia Management Program Reduces Transfusion Volumes, Incidence of Ventilator-Associated Pneumonia, and Cost in Trauma Patients. The goal of their research was to decrease transfusions of packed red blood cells and cost by implementing an anemia management program (AMP) (Earley, Gracias, Haut, 2006).

AMP was a new guideline which