Managing Blood Loss

What are Your Options for Managing Potential Blood Loss?

There are 3 categories of options for managing the potential loss of blood during surgery.

1. Replace the blood lost with blood donated by a volunteer of your own blood that you have pre-donated.

2. Recycle and conserve blood lost during surgery; these options involve special equipment and techniques to minimize blood loss and return blood to the patient.

3. Reproduce more red blood cells by taking iron supplements and/or hormone replacement.

The best alternative may be a combination of these. However, not all alternative may be available at your hospital and not all alternatives may be suitable for you. It is important that you plan with your physician prior to surgery to understand the benefits and risks of each option, and to make sure that the option you choose is available.

Recycling and Conserving Blood

You can reduce blood loss by using hemostatic scalpels that cut tissue and stop bleeding at the same time. These include electrocautery (heat), electrosurgery (electric current), laser surgery (light), and ultrasonic scalpel (vibration).

Minimally invasive techniques include the use of laparoscopes ("keyhole" incisions) and endoscopic surgery (slender, tube-like instruments to visually examine structures like digestive tracts).

Blood salvaging devices can be used during or after surgery to collect the patient’s blood, wash or filter it, and return it to the patient. This reduces the need for transfusion of donated blood.

Hemodilution is a technique in which several units of blood are collected from the patient immediately before surgery and replaced with a volume expander. Because your blood is diluted, fewer red blood cells are are lost through bleeding. After surgery, your own blood is given back.

Benefits The key benefit of the recycle and conserve technique is convenience. Importantly though, you lose fewer red blood cells during the operation, which means you are less likely to require a blood transfusion.

Risks These techniques require planning with your physician prior to surgery. And they may not eliminate the need for a transfusion.

Replacing Blood

a) Transfusion with donated blood

Benefits If you lose a lot of blood during surgery and your hemoglobin falls very low, one benefit of a blood transfusion is that it immediately provides your body with additional red blood cells. If the blood comes from a volunteer donor, it is important that the blood is matched to your blood type. If you and your physician decide that you might require a blood transfusion, your own blood will be tested prior to surgery to make sure that the right type of blood is available.There is little pre-planning required for a transfusion with donated blood.

Risks While the blood supply is safer than ever, there are still some risks receiving donated blood.

Blood transfusions may cause side-effects such as fever, hives or rejection reactions. The main cause is incompatibilities between your blood and the donated blood. There is a small risk of bacterial contamination. While donated blood is tested for most known viruses, including HIV and Hepatitis B and C, there is still a small risk of viral infection and disease transmission.

If your type of blood is not available on a particular day, your surgery may need to be postponed or cancelled. And, finally, clerical errors do occur, although rarely, so you could end up receiving the wrong blood.

b) Transfusion with your own blood

Benefits The benefits of autologous blood is that you have perfectly matched blood.

Risks The risk of infection is reduced, although not completely eliminated since stored blood can develop bacteria. A common risk is that your body may not have sufficiently replace the red blood cells that you donated and you may be anemic going into surgery. This may put you at higher risk for needing a blood transfusion.

Clerical errors can occur and you any receive the wrong blood. Finally, it is important to know that pre-donating your blood does not guarantee that you will not need a transfusion of donor blood.

If you decide to pre-donate your own blood, you will need to plan this with your doctor at least 6 to 8 weeks before your surgery. Your doctor will assess your health to ensure that you are able to donate. The blood is collected over tow or more clinical appointment and stored for use during your surgery.

Recycling and Conserving Blood

You can reduce blood loss by using hemostatic scalpels that cut tissue and stop bleeding at the same time. These include electrocautery (heat), electrosurgery (electric current), laser surgery (light), and ultrasonic scalpel (vibration).

Minimally invasive techniques include the use of laparoscopes ("keyhole" incisions) and endoscopic surgery (slender, tube-like instruments to visually examine structures like digestive tracts).

Blood salvaging devices can be used during or after surgery to collect the patientÕs blood, wash or filter it, and return it to the patient. This reduces the need for transfusion of donated blood.

Hemodilution is a technique in which several units of blood are collected from the patient immediately before surgery and replaced with a volume expander. Because your blood is diluted, fewer red blood cells are are lost through bleeding. After surgery, your own blood is given back.

Benefits The key benefit of the recycle and conserve technique is convenience. Importantly though, you lose fewer red blood cells during the operation, which means you are less likely to require a blood transfusion.

Risks These techniques require planning with your physician prior to surgery. And they may not eliminate the need for a transfusion.

Reproducing Red Blood Cells

Both iron and a hormone called erythropoietin are required to produce hemoglobin-rich red blood cells.

Hemoglobin is made from iron. If you have too little iron, you may need to include iron-rich foods in your diet prior to surgery. Good sources are liver, lean beef, chicken or turkey (dark meat), dried fruits, whole grain cereals, and dark green, leafy vegetables (spinach and broccoli). Your physician may prescribe iron, vitamin B12 or folic acid.

Your physician may also prescribe a medication, recombinant erythropoietin, or EPO. EPO is a genetically-manufactured copy of a hormone found naturally in the body that stimulates red blood cell production. EPO requires a prescription and is given by injection. By building up your red blood cells (and hemoglobin) before your surgery, you are less likely to require a transfusion, even if you lose some blood during your operation.

Benefits By increasing your red blood cell count prior to surgery, you may avoid a blood transfusion. You may also feel less tired and run down.

Risks Iron tablets may cause stomach discomfort for some patients. If your physician decides that you may benefit from EPO, treatment must be planned ahead of time. Injections may be given in hospital or by your family doctor, one to three times a week for three weeks prior to surgery.

Do I Have a Choice of Options

You must be informed and provide consent before any medical treatment can be given to you. Because all medical therapies involve some degree of risk, patients have the right to make choices about their treatment. You have the right to receive information about the benefits and risks of the various options.

Some hospitals and some provinces have developed standardized procedures for informing patients and obtaining consent if they may need a blood transfusion. In all cases, you have the right to discuss alternatives with your physician and to provide consent before you receive blood or any other treatment. In some provinces and some hospitals, you may be required to sign a form if you do not wish to receive blood.

What Now?

Discuss these options with your physician, and make an informed decision with which you are comfortable.