More hospitals and physicians are turning to bloodless surgery or blood conservation because it is believed to be healthier, safer and less costly for patients than standard surgical procedures.
The principle goal of bloodless medicine or patient blood management (PBM) is to minimize blood loss and to reduce or eliminate exposure to allogeneic (genetically different) blood transfusion. The goal of bloodless surgery centers is to avoid unnecessary use of blood that may lead to risk of infection or other complications. The risks associated with blood transfusions have been well documented.
Overall, patients who avoid transfusions have fewer complications, faster recoveries and shorter hospital stays. Specific benefits include: lower rates of the most serious postoperative complications, including heart attack, stroke, and infections; decreased risk of immunological complications and allergic reactions; less exposure to blood-borne viruses and infections; and no risk of receiving the wrong blood type or facing a blood shortage on the day of surgery.
Many people object to receiving blood or blood products as part of their medical treatment. Some, such as Jehovah’s Witnesses, object due to religious beliefs, while others do so as a result of healthcare concerns, knowledge of potential complications or other personal convictions.
How Does It Work?
The practice of Patient Blood Management involves a combination of medical and surgical techniques, as well as technology and behavioral strategies to decrease blood loss and enhance a patient’s own blood supply.
At Englewood Hospital and Medical Center (EHMC) patient blood management is a hospital-wide effort. An entire healthcare team, composed of physicians, nurses, pathologists, pharmacists, dietitians and support staff, works together to assess and address each patient’s blood management needs.
Prior to surgery, based on the results of a patient’s blood test, doctors may recommend a regimen of medications and dietary supplements to ensure optimal levels of hemoglobin (an oxygen-carrying protein in red blood cells). During surgery, doctors may use a variety of state-of-the-art technologies and techniques to minimize blood loss.
Among the technologies that make bloodless surgery possible are: hyperbaric oxygen therapy—distributes high concentrations of oxygen into blood prior to surgery, helping patients better withstand surgical procedures; minimally invasive surgery and meticulous surgical techniques—surgical instruments and techniques specially designed to minimize blood loss by using the smallest or most efficient incisions; blood salvage/cell saver—a device that recycles a patient’s own blood that is lost during surgery, collects it, cleans it and returns it to the patient; oximetry—tracks oxygen levels during surgery; argon beam coagulator—coagulates or clots blood during surgery to minimize blood loss; hemostatic drug therapy—medications that assist with the clotting functions of blood; volume expanders and hemodilution—enhances the circulation of the patient’s own blood via intravenous fluids; synthetic erythropoietin—smulates bone marrow to produce enough red blood cells to obviate transfusion; harmonic scalpel—a scalpel that employs vibration and friction to cut and cause blood clotting at virtually the same time; and electro cautery–uses heat to stop vessels from bleeding.
After surgery, blood loss will be minimized and blood production is enhanced through medication and nutrition therapy as well as technology—including the use of post-operative blood salvage and hyperbaric oxygen therapy.
Bloodless Excellence in New Jersey
At EHMC, recognized as a world leader in patient blood management, the clinical team agrees to provide bloodless (transfusion-free) medicine and surgery to patients who request it. More than 200 physicians from every medical discipline at EHMC practice bloodless techniques, and procedures as complex as brain, open-heart and orthopedic surgery are regularly performed at the facility without blood transfusions.
Institute coordinators provide patients with information and counseling on bloodless care and assist them in completing appropriate documents. Individuals are then identified as “bloodless patients” throughout their hospital stay, allowing physicians, nurses and other members of the healthcare team to honor their request.
Aryeh Shander, M.D., is chief of Anesthesiology, Critical Care Medicine and Hyperbaric Medicine at Englewood Hospital and Medical Center.