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With an increasing focus on the value of health care received by patients, emphasis has predictably shifted toward eliminating costs and resource utilization that does not result in improved clinical outcomes. Blood products represent an expensive and labor-intensive resource, accounting for approximately 1% of hospital expenditures.1 External wastage occurs when blood products are not returned to the blood bank within a time or temperature range that allows for their safe return into inventory. The standards set forth by the AABB dictate that the temperature of red blood cell (RBC) units must be maintained between 1 and 6°C to be available for issue.2 Due to the difficulty in monitoring the temperature of RBC units after they leave the blood bank, many transfusion services have adopted a standard allowance of 30 minutes for the return of blood products.3,4 If RBCs are returned to the blood bank within 30 minutes of issue, it is thought that they may be safely returned to inventory, often in the absence of local time and temperature data. The wastage of blood products during the normal course of hospital operations represents a direct cost to health care organizations and is the result of process deficiencies in inventory blood product ordering, transport, and storage. The annual direct cost of intraoperative RBC wastage at Vanderbilt University Medical Center (VUMC) amounted to approximately $249,314 in 2010, using an estimated direct cost of $225.42 per unit of leukoreduced RBCs.5 This figure does not account for the overhead costs associated with the procurement, management, storage, and issue of these products. In addition to the financial cost associated with RBC wastage, the presence of RBC units outside of the blood bank that are not actively being transfused introduces additional potential for mistransfusion as they are out of the direct control of both the blood bank and the intended transfusionist. The high-acuity nature of the perioperative area occasionally requires immediate availability of large volumes of RBCs resulting in a tendency to order and store blood products “just in case” of clinical need, likely contributing to RBC wastage. After previous provider education and reminder-based efforts at this institution failed to result in sustained reductions in perioperative RBC wastage, we hypothesized that RBC wastage in the operative environment could be reduced by 50% using process and quality improvement methods.

Introduction Haemophilia A is an X-linked recessive bleeding disorder that primarily affects males. Emerging data support evidence for increased bleeding in female haemophilia A carriers despite factor VIII activity within the normal range. Aim Data regarding the effect of increased bleeding on health-related quality of life (HR-QOL) in haemophilia A carriers is sparse. We tested the hypothesis that haemophilia A carriers have reduced HR-QOL related to bleeding symptoms. Methods We conducted a cross-sectional study at Vanderbilt University. Case subjects were obligate or genetically verified haemophilia A carriers age 18–60 years. Control subjects were mothers of children with cancer who receive care at the Vanderbilt paediatric haematology-oncology clinic. Trained interviewers administered the Rand 36-Item Health Survey 1.0, a validated questionnaire evaluating eight health concepts that may affect HR-QOL, to each study participant. Mann–Whitney U-tests were used to compare median scores for the eight health domains between the case and control groups. Result Forty-two haemophilia A carriers and 36 control subjects were included in analyses. Haemophilia A carriers had significantly lower median scores for the domains of ‘Pain’ (73.75 vs. 90; P = 0.02) and ‘General health’ (75 vs. 85; P = 0.01) compared to control subjects. Conclusion Haemophilia A carriers in our study demonstrated significantly lower median scores on the Rand 36-item Health Survey 1.0 in the domains of ‘Pain’ and ‘General Health’ compared to women in the control group. Our findings highlight the need for further investigation of the effect of bleeding on HR-QOL in this population.

Haemophilia A carriers have historically been thought to demonstrate normal haemostasis. However, recent data demonstrates that despite normal factor VIII, haemophilia A carriers demonstrate an increased bleeding tendency. We tested the hypothesis that obligate haemophilia carriers demonstrate an increase in bleeding symptoms. A cross sectional study was performed comparing haemophilia A carriers to normal women. Questionnaire assessment included a general bleeding questionnaire, condensed MCMDM-1VWD bleeding assessment tool and Pictorial Bleeding Assessment Chart (PBAC). Laboratory assessment included complete blood count, prothrombin time, activated partial thromboplastin time, fibrinogen activity, FVIII activity (FVIII:C), von Willebrand factor antigen level, ristocetin cofactor, platelet function analyser-100™ and ABO blood type. 44 haemophilia A carriers and 43 controls were included. Demographic features were similar. Laboratory results demonstrated a statistically significant difference only in FVIII:C (82.5 versus 134%, p value < 0.001). Carriers reported a higher number of bleeding events, and both condensed MCMDM-1 VWD bleeding scores (5 versus 1, p value < 0.001) and PBAC scores (423 versus 182.5, p value = 0.018) were significantly higher in carriers. Haemophilia A carriers exhibit increased bleeding symptoms when compared to normal women. Further studies are necessary to fully understand the bleeding phenotype in this population and optimize clinical management.