The decision to develop a formal Bloodless Medicine Program to attract and effectively care for patients who decline blood transfusion was made in 1998 by clinical and administrative leaders at our flagship hospital, Allegheny General Hospital, part of the Allegheny Health Network. The Bloodless Medicine Program has more than 20 years of experience in caring for this sometimes challenging patient population and with this experience has provided extensive insight into best practices related to effective, safe, patient blood management. Patient blood management is a patient-centered, evidence-based approach to transfusion that seeks to provide the right care, in the right setting, in the right way, every time. It includes honoring the wishes of patients who decline blood products in their care, that is, "bloodless" medicine. Encouraging patients to participate in their own health care decisions is a vital part of safe, compassionate care. When called upon to provide care to a patient who declines a common therapy such as blood transfusion, clinicians must often develop alternative strategies to achieve the desired results. Their willingness to think creatively and push boundaries has resulted in significant advancement of clinical knowledge and practice related to the use of blood products for all patients. Nurses who advocate for the best care for their patients are a vital component of any successful patient blood management program.
Background Convalescent plasma (CP) is often administered to hospitalized patients with COVID-19, but the impact on clinical outcomes has varied across different patient populations. Methods A retrospective, propensity score–matched controlled study was conducted to compare outcomes of hospitalized patients with nonmechanically ventilated severe COVID-19 who received CP within 36 hours of hospital admission with those who did not receive CP during their hospitalization. A combination of propensity score matching and Mahalanobis distance matching was used. Results One hundred forty-three patients were originally in the treatment group, and 94 were able to be matched to control patients who did not receive CP during their hospital stay. Receipt of early CP was not associated with significant differences in clinical outcomes. Overall 30-day mortality was 12.8% in the CP group and 14.9% in the non-CP group (P = 0.67). No significant differences were observed between the early CP group and the non-CP group for 30-day readmissions (12.8% vs 9.6%; P = 0.47), subsequent transfer to an intensive care unit (2.1% vs 2.1%; P = 1.0), and subsequent progression to noninvasive ventilation after 36 hours from admission (12.8% vs 5.3%; P = 0.07). Receipt of early CP was associated with increased need for mechanical ventilation after 36 hours from admission (12.8% vs 3.2%; P = 0.013). Conclusions Receipt of early CP for hospitalized patients with severe COVID-19 but not requiring mechanical ventilation was not associated with improvements in clinical status or mortality compared with matched patients who did not receive CP.
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