Blood Transfusion on CPB
I usually know if I am going to transfuse a patient during the course of cardiopulmonary bypass.
Aside from the obvious co-factors associated with blood product administration (Kg, gender, HgB, age, susceptibility to stroke, estimated hemodilution, platelet count, antiplatelets Rx, and a few others), surgical dynamics also come into play.
But while it is uncomplicated for me- in terms of initiating the process, it is obvious that the entire sequence of events in terms of getting a unit of blood to the patient goes far beyond the $400-$800 that the hospital spent to purchase it.
While the purchase price of a unit of Packed Red Cells is fairly static, the cost to the institution is significantly more sublime and difficult to abstract in terms of tallying the steps and identifying process events, incumbent tests, cost of capital equipment and disposable supplies, and total man hours to achieve the goal.
To process one unit of PRC’s It is broken down as such:
- Indirect Overhead- 40.6%
- Total transfusion Process Costs 34%
- Avg Acquisition Cost 21.5%
- Direct Overhead 3.9%
So what is the TRUE cost of 1 PRC ?
- Estimates vary- but it is more in the $1,600 – $2,400 arena.
A brief Review of Packed Red Blood Cells
Red blood cells, or packed red blood cells, are prepared from whole blood collected in one of several approved anticoagulant solutions. The usual 250-300 ml unit of red blood cells (RBCs) has a hematocrit of 55-80%, with some platelets and/or white cells removed during processing. Removal of plasma reduces the risk of adverse reactions.
Collection and Processing
Most frequently, whole blood is collected from a blood donation and is spun in a centrifuge. The red blood cells are denser and settle to the bottom, and the majority of the liquid blood plasma remains on the top. The plasma is separated and the red blood cells are kept with a minimal amount of fluid. Generally an additive solution of citrate, dextrose, and adenine is mixed with the cells to keep them alive during storage. This process is sometimes done as automated apheresis where the centrifuging and mixing take place at the donation site.
Red Blood Cells are sometimes modified to address specific patient needs. The most common modification is leukoreduction, where the donor blood is filtered to remove white cells. The blood may also be irradiated, which destroys the DNA in the white cells and prevents graft versus host disease, which may happen if the blood donor and recipient are closely related. Other modifications, such as washing the RBCs to remove any remaining plasma, are much less common.
With additive solutions, RBCs are typically kept at refrigerated temperatures for up to 42 days.
Point A to Point B
The diagrams below were from a University of Michigan Study and take you down the convoluted pathway a unit of blood takes before I spike it and drop it into my reservoir.
Click on Images Below to Enlarge
Straight to Point B
(For TRUE emergencies some steps may have to be missed )
The True Cost of Red Blood Cell Transfusion in Surgical Patients
Journal of Pathology Informatics