Patient Blood Management: Honoring Wishes, Providing Options

When it comes to using transfused blood at Lehigh Valley Health Network (LVHN), the network’s patient blood management program leads the way in offering customized options for patients.

“Care is individualized for each person to help ensure the best possible outcomes,” says Warren Behr, Director, patient blood management, LVHN. “Patient blood management is a multidisciplinary approach that has a variety of benefits, including improved patient safety and quality of care. It leads to better-informed transfusion decisions.”

Blood transfusions are one of the most common procedures in U.S. hospitals, yet they don’t come with zero risk. In addition to offering options for patients with religious or ethical beliefs against transfusions, patient blood management also helps those with concerns about transfusion-related complications, or people with underlying medical conditions that could make transfusions risky.

“Good patient blood management means you employ best practices to avoid transfusions, if possible,” Behr says. “LVHN has made huge strides over the past five years to transfuse more appropriately. We are exposing patients to fewer transfusions, less risk, and saving blood for those who truly need it.”

The terms bloodless medicine or bloodless surgery probably seem impossible at first glance. How’s it even possible?

For starters, you can’t take the term literally. It doesn’t mean there won’t be any blood present during a surgery, or no blood loss, as the term might imply.

Rather, it’s an approach to health care that aims to minimize or eliminate the need for blood transfusions during medical procedures, such as surgery. It focuses on strategies to conserve and manage a person’s own blood, reduce bleeding and use alternative treatments to maintain blood volume. It provides a safer and more tailored approach to care for people who want to avoid blood transfusions.

Bloodless surgery employs several techniques to minimize blood loss, including intraoperative cell salvage. In this procedure, a machine collects lost blood and cleans it so that your red blood cells can be reclaimed and returned to you during the surgery. One advantage of this technique is a reduced need for donor blood.

Doctors also may use advanced hemostatic agents, which are substances that help prevent or stop bleeding by promoting coagulation or clotting.

Hemodilution is another strategy. Here, a set amount of your blood is drawn before your surgical procedure begins. You are then given a fluid that helps maintain your blood volume. Red blood cell loss during surgery is reduced because the remaining blood is thinned with fluid. During surgery or immediately after, your drawn blood is given back to you. 

Clinicians also may employ special surgical techniques and minimally invasive procedures to minimize blood loss.

There’s also preoperative optimization, which covers a variety of approaches including optimizing diet, increasing vitamins such as C and folic acid to help with absorption of iron, and discussing what homeopathic or herbal supplements you may be taking that could increase your risk for bleeding.

While bloodless medicine and surgery aims to minimize risks, there are potential challenges, such as a slightly increased risk for anemia or the need for a more cautious approach to certain medical procedures. However, medical teams trained in bloodless techniques strive to balance these risks with the benefits of avoiding blood transfusions.

Anemia, a lower-than-normal amount of red blood cells, is a common concern for people seeking bloodless care. It’s managed through strategies including iron supplementation, preoperative optimization and erythropoietin-stimulating agents, which are medications that stimulate your bone marrow to make red blood cells.

These methods help boost your red blood cell count before surgery, reducing the risk for anemia-related complications.

About 18 million blood transfusions occur each year in the U.S. Transfusions save lives every day. For trauma victims to newborn babies to cancer patients, transfusions have tremendous benefit.

But not all transfusions are necessary, and some studies point to unneeded blood use.

Behr says LVHN’s transfusions are much more targeted now. “We are giving the minimum dose required and waiting until the patient truly needs transfusion therapy in far more cases than ever before,” he says.

As an example, Behr says, a patient transfused five years ago had a 50% chance of receiving two or more units of red blood cells versus just one unit. Now, the frequency is down to 20-22%.

“Clinicians are more often giving a patient one unit and then assessing the situation, rather than going immediately to multiple units,” Behr says. “It’s a shift that’s having a positive impact across the board.”