This represents a direct cost savings of $291,000 on the price of red blood cells and an indirect cost savings of $964,600 in lab and facility costs associated with transfusion. Over the same time period the number of patients by volume in RQHR increased by 2.5%.

There has been a tremendous uptake amongst all staff in using appropriate transfusion guidelines, including limiting transfusions to those whose hemoglobin is below 70g/L or lower in stable, non-bleeding patients and 80g/L in those who have symptoms of ischemia. When blood transfusions are being ordered, the majority of clinicians are choosing wisely and ordering single unit transfusions. We have also witnessed a shift towards using intravenous iron in stable, non-bleeding patients. Compared to blood transfusion, intravenous iron has a ten-fold lower risk of all comparable complications, and no biological risks including alloimmunization, immunomodulation, or human to human transmission of pathogens.

So congratulations. Bragging rights are in order. There is still work to be done on our management of outpatient anemia, but we have a considerable head start in the province of Saskatchewan, and all members of the health care team are to be commended.

If you would like to learn more about how you can improve transfusion appropriateness in your clinical care area, please visit www.saskblood.ca or contact pbm@saskblood.ca.

Submitted by: Dr. Ryan Lett