Alternatives - PBM

Cutting Edge Technology is the program's success due to the combination of our experienced surgical team using the most up-to-date techniques. Some of the techniques and alternatives that can be used to decrease or eliminate the need for blood transfusion before and during planned surgery.

What are the alternatives to receiving donated blood?

There are several options for patients, but not all are appropriate for every individual.

No Transfusion

The health risks from not having a transfusion when needed are much greater than from having a transfusion. Many types of surgery and treatments for cancer are usually not possible without transfusions of blood components or products.

If you require elective surgery (your surgery is scheduled well in advance), your surgeon, Perioperative Blood Management Service and family doctor will work together to ensure that you are as healthy as possible.

When getting ready for an operation, the need for blood transfusion can be decreased or avoided by careful planning. Using blood management strategies does not rule out the possibility of needing a blood transfusion. The stronger that you are going into surgery, the less likely it is that you will need a blood transfusion.

Preoperative period (in the weeks before surgery)

Iron therapy

When you lose blood from an operation, you lose iron. Building red blood cells can help your body deal with the stress of losing blood during an operation and speed recovery.

• An Iron Healthy Diet
• Iron Supplements
• IV (Intravenous) Iron

Usually, the IV iron treatment is not enough iron to completely fix a low iron level. The blood management team will recommend iron supplements that are best for each individual patient.

• Vitamin B12
• Folate (Folic acid)
• Erythropoietin - (a hormone in your kidneys that stimulates the red cell production in your body) If you are very anemic, your doctor may also give you a medication called erythropoietin to stimulate your body to produce new red blood cells. It takes several weeks for these medications to have their effect.

Before your surgery, if your surgeon tells you to stop medications such as Aspirin®, Plavix®, Ibuprofen (Advil®), Warfarin (Coumadin®) or any other drugs, it is important for you to stop taking them. These drugs can affect platelet function. If you have any questions about how medications affect the function of your platelets, please ask your physician.

Drugs that help blood to clot before surgery

• Vitamin K
• Octaplex

Donating Your Own Blood (Autologous Donation)

This is called an autologous blood donation (donation for yourself). Your physician must make arrangements with Canadian Blood Services in four to six weeks in advance of your surgery date in order for you to make your own blood donation. This blood is marked only for your use.

It will not be used by any other patient if you do not require a transfusion. Using autologous blood can eliminate the risk of transmissible disease or antibody production to donor blood. If you require more blood than you donated, you may have to receive blood from other donors. Please discuss this with your doctor.

Can I donate for a family member or friend?

This is called a directed donation (donation for a specific person). Currently in Nova Scotia, parents who are eligible may provide their blood for their children. This must be arranged through your physician and Canadian Blood Services and is not available in emergency situations. Usually these donations occur four to six weeks before a pre-booked surgery. Directed donations, like autologous donations, are only used for the specific patient. They cannot be given to others.

Intra-operative Period (during surgery)

Drugs that help blood to clot

• Acute Normovolemic Hemodilution (ANH) - is performed by the anesthesiologist in the operating room while the patient is unconscious. If necessary, the anesthesiologist can remove whole blood from the patient, and replace it with saline (a salt solution). This is called hemo-dilution because the saline dilutes the patient’s blood. The blood that was removed is stored in the operating room with the patient. If the patient bleeds, the anesthesiologist returns their own blood back to him or her. Usually, you need to be a healthy person to undergo this procedure. Discuss any questions you have with your surgeon or anesthesiologist.
• Antifibrinolytic Drugs - drugs that help blood to clot
• Cell Saver (Blood Salvage) is another means of giving the patient’s own blood back to them at the time of surgery.
• Desmopression DDAVP
• Electrosurgical and Ultrasonic Harmonic Scalpel Coagulators - Coagulates or clots a patient's blood during surgery in order to reduce blood loss
• Endoscopic and Laparoscopic Surgery - surgery is done through a surgical tube so there is a smaller incision
• Floseal®, Hemostatic Matrix
• Hypothermia - lowering your body temperature to decrease your oxygen consumption
• Hypotensive anesthesia - lowers blood pressure so blood is less likely to leak
• Instat* MCH
• Laser Surgical Techniques - uses laser light to remove diseased tissues or treat bleeding blood vessels
• Pediatric sampling - a smaller than usual amount of blood is withdrawn from the patient for laboratory testing
• Pulse Oximetry - Tracks oxygen levels during surgery
• Surgicel
• Tisseel®, Fibrin Sealant - is a combination of different proteins that are involved in blood clotting.
• Volume Expanders - Pentaspan® & Voluven® - Non-blood fluids administered intravenously to increase blood volume

These options may be available to surgery patients, but not all are right for every individual.

Does artificial blood exist?

No. Most often when people think about artificial blood, they imagine something that doesn’t contain any blood, but still carries oxygen throughout the body. Scientists haven’t yet been able to design a product like that. There are products called blood substitutes but they are NOT licensed for clinical use (not licensed to be given to patients) in either Canada or the United States.

Can I refuse a transfusion?

A competent person is entitled to refuse or stop a treatment. If you do not want a transfusion for any reason including religious beliefs, you must inform your doctor.
However, there are risks associated with refusal. Ask your doctor. Your doctor will be able to give you more information about these choices.