Routine surgeries could be delayed due to a shortage of blood, experts have warned. Supplies are at about half their normal level and hospitals have been told they should be ready to implement emergency measures – possibly as early as this month – if the situation worsens.
This would include reducing the number of non-emergency elective surgeries, such as joint replacements, which require sufficient blood supplies in case a patient bleeds heavily.
Already around 6.5 million patients are on waiting lists for such operations, of which around 300,000 are waiting at least a year.
“The shortage means that hospitals will have no choice but to delay procedures because it will not be safe to go ahead,” says Professor Ian Roberts, one of the UK’s leading experts in the field. of blood loss, based at the London School of Hygiene and Tropical Medicine.
In July, Health Secretary Steve Barclay issued an urgent appeal for blood donations, warning that stocks were at half their normal level, but insisted that there were still “a lot of stationery”.
Hospitals will be forced to postpone many routine procedures as they do not have sufficient blood stocks to allow them to take place safely
In July, new Health Secretary Steve Barclay, pictured, urged people to donate blood to replenish stocks. Otherwise, NHS bosses will be forced to implement an emergency blood shortage plan
However, NHS Blood And Transplant sent a letter to UK haematology services the same month which appears to present a more desperate picture. The correspondence, seen by the Mail on Sunday, spoke of ‘concerns about the adequacy of the supply over the next few weeks’ and urged staff to ‘remain ready to implement’ a contingency plan in the event of a blood shortage .
Another letter sent on August 30 said blood levels continued to be “lower than we would like”, but gave no timetable for crisis measures.
Further emails between NHS England and NHS Blood And Transplant say it is ‘expected’ that blood can be withheld from elective surgeries by the end of this month.
The NHS has an official traffic light system to manage low blood levels. Currently the UK is in ‘pre-amber’ meaning there is only just enough blood to meet demand. NHS staff are advised to be careful not to waste stock and try to hold back blood types that are most likely low. The next step is amber, when hospitals must “reduce and prioritize” the use of blood.
But experts say a key tool that could help procedures move forward is being overlooked in NHS hospitals. A medicine called tranexamic acid cuts heavy blood loss by a quarter when given before an operation. The National Institute for Health and Healthcare Excellence (Nice) recommends that it be given to all patients undergoing major operations, but doctors do not offer it.
Last year an audit of 152 NHS hospitals found that a third of eligible patients were not offered the drug at £2 a dose. A report to be published tomorrow in the British Journal of Anesthesia suggests giving the jab to all hospital surgical patients could prevent 15,000 major bleeds each year.
“This makes perfect sense for doctors and patients alike,” says Professor Roberts, one of the report’s authors. “This is an inexpensive, low-risk intervention that will save tens of thousands of units of blood and lives.”
Currently, around 13,000 Britons die each year from major bleeding during surgery. Professor Roberts adds: “Not only do more doctors need to offer tranexamic acid, but we want every patient having surgery to know that they can and should ask for it.”
It is injected into the thigh muscle or a vein in the arm and works by blocking the release of compounds that stop blood clotting. The drug has long been used to treat major bleeding in traffic accident victims and women with extremely heavy periods. Studies also show that it is very effective in preventing blood loss before injuries occur.
In the letter sent last week, NHS Blood And Transplant urged consultants to use tranexamic acid ‘before major operations’ to help save the blood supply. But Prof Roberts says ‘outdated’ views on the drug’s safety may prevent some doctors from using it.
Older studies have linked tranexamic acid to a small increased risk of life-threatening blood clots in the days following treatment. However, recent trials involving more than 40,000 patients found these fears to be unfounded. Other large trials have shown that giving patients the injection 20 minutes before routine operations, including joint surgery, can reduce the risk of needing a blood transfusion by up to a third, without an increased risk of blood clot.
‘Patients should at least have a choice,’ says Professor Roberts. “A blood transfusion can be traumatic for a patient, often involving a long convalescence and several additional nights in hospital. Too many doctors are unaware of the latest evidence that proves how safe and effective this drug is.
Last year The Mail on Sunday revealed alarming data which showed that only 5% of accident victims who could benefit from tranexamic acid were given it by emergency doctors.
‘Doctors usually find out about drugs through pharmaceutical marketing campaigns, but because it’s an old and cheap drug, no one talks about it,’ says Professor Roberts. “NHS hospitals are going to have to start using it if they want to find a simple solution to these terrible shortages.”
NHS Blood And Transplant said there was sufficient blood stock for ‘current clinical need’, adding: ‘The aim now is to prevent the stock from falling further, if supplies reach the orange stage [hospitals] potentially delay operations.
- Visit blood.co.uk to register to become a donor and find your local blood donation clinic.