Transfusion-Free Cardiothoracic Surgery
Surgical Tricks of the Trade:
Specialized Techniques Make a Complex Surgery Manageable
Boosting Blood Levels: The First Step
Several techniques are used prior to heart surgery to help boost red blood cell volume so that a patient can withstand some blood loss. Red blood cell volume is measured by hematocrit levels, which are calculated as the percentage of total blood volume.
Many things can be done to increase hematocrit levels. First, blood tests are done sparingly. Second, patients receive supplemental iron and folic acid, and a medication called Epogen. Erythropoietin is a hormone-like substance produced by the kidneys that stimulates the bone marrow to produce red blood cells. Epogen is similar to the naturally produced erythropoietin and has the same effects--stimulating the bone marrow to make red blood cells.
The second critical step in transfusion-free surgery is the implementation of a variety of innovative intraoperative techniques utilized by the anesthesiology team at Keck Hospital of USC.
One advanced blood management technique is called acute normovolemic hemodilution. This approach involves collecting the patient's whole blood immediately prior to surgery. The rest of the patient's blood is diluted with non-blood products such as normal saline or other IV solutions. Consequently, if the patient bleeds during surgery, he or she is bleeding diluted blood. Once the operation is completed, the patient receives the concentrated blood that was collected prior to surgery.
In addition, an innovative device is used for the acute normovolemic hemodilution procedure that keeps the patient's collected blood in circuit through a bypass machine. Since there is still a connection with the body, the collected blood can be transfused back into the patient. This allows Jehovah's Witness patients to observe their religious beliefs concerning blood products.
Another intraoperative technique involves a "cell saver." This device recycles a patient's own blood that is lost during surgery, collects it, cleans it and returns it to the patient--another acceptable approach for Jehovah's Witness patients.