Blood conservation helps avoid transfusion trauma
It may be the latest buzzword in medicine, but blood conservation is here to stay, local experts say.
Blood conservation is a way to conserve and strengthen a patient's own blood so that a blood transfusion isn't needed during surgery.
Blood conservation is good for hospitals because it saves them money, and it's good for patients because, in general, people who don't use blood transfusions - even transfusions of their own stockpiled blood - during surgery do better medically, says Richard Melseth, director of Blood Conservation Medicine at Banner Good Samaritan Medical Center in Phoenix. Banner is a recognized Arizona leader in blood conservation techniques.
Dr. Peter Tibi, head of Yavapai Regional Medical Center's Heart Center in Prescott and the hospital's director of cardiothoracic (heart/lung) surgery, agrees.
He's been using blood conservation strategies and specialized medical equipment since The Heart Center opened at YRMC's west campus in Prescott in the summer of 2007, and he helped Banner start its blood conservation program.
"It's not anything that's all that difficult to do," Tibi said.
He makes sure patients with anemia get it taken care of well before their surgery. He also puts patients on medicine that stimulates their own body to make even more blood.
During surgery, Tibi uses surgical techniques that conserve the patient's blood along with a special state-of-the-art heart/lung bypass machine called a Medtronic pump that limits trauma to the patient's blood so more of it can be sent back into the patient's body.
Tibi said patients who need blood transfusions during surgery suffer a higher risk of kidney and cerebral problems and even death.
That's why he's a vocal proponent of blood conservation, Tibi said. He noted that typically 50 to 70 percent of open-heart surgery patients require transfusions. But since The Heart Center opened, only 10-15 percent of its open-heart patients have needed transfusions because of the blood conservation the center practices.
Banner's Melseth said patients also face risks from the donor blood supply itself, even though blood banks take strict precautions to ensure the safety of the nation's blood supply.
For example, he said, blood banks have only recently begun testing for Chagas disease, a fatal and incurable parasitic disease pervasive throughout Central and South America. While it has been around for many years, only recently have immigration patterns forced testing of the U.S. blood supply.
Other pathogens could exist undetected, Melseth said.
Even stockpiling a patient's own blood has issues, Melseth said, because blood stored outside of the body for even a short time carries its own set of risks.
Hospitals save money using blood conservation practices in several ways, Melseth and Tibi said.
Patients who don't use transfusions during their surgery leave the hospital an average of two days sooner. Because Medicare pays a set amount of money for a specific procedure no matter how long a patient stays in the hospital, Melseth said, longer stays eat into a hospital's profits.
Tibi said surgical transfusions also cost hospitals money because they must pay for the first few pints of blood patients use and for any drugs administered to hospitalized patients to make them healthy enough to have a transfusion. If patients get those drugs outside the hospital setting - which is a technique of blood conservation - then the patient's insurance pays.
Tibi said YRMC hopes to expand the use of blood conservation by getting the word out to doctors who do surgery at the hospital - especially orthopedic surgery - and by encouraging patients to ask their doctors to practice blood conservation during their surgeries.
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