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Blood Transfusions

Most surgeries don’t require blood transfusions and most surgeons will try to avoid these transfusions if possible. However, if you absolutely need a transfusion several options exist that you should be aware of. The patient always has a right to refuse a blood transfusion, but this decision may have life threatening consequences. The information below will help and inform the patient in this decision making process. This information is only a guide, but your physician can provide you more information regarding timelines and procedures.

Before beginning this page some terms need to be clarified. Autologus blood means using your own blood. In cases that blood loss is anticipated, the patient may choose to donate their own blood prior to surgery so that in case a blood transfusion is needed the patient’s own blood can be used.

Pre-operative Donation

Option: Donating your own blood before surgery.

Explanation: Your own blood is drawn 2-4 weeks before surgery, is tested, and stored in blood bank until or if needed.

Advantages: Avoids the need to transfuse blood from someone else.

Disadvantages: Must be done in advance (2-4 weeks) & may delay surgery. Not all patients are candidates.

Intra Operative (in the operation) transfusion

Option: Intra Operative (in the operation) transfusion recycling also called “Cell Saver” machine.

Explanation: Blood lost in the wound is collected by a machine called Cell Saver. The blood is recycled and given back to the patient as needed later.

Advantages: Avoids the need to transfuse blood from someone else. Large amount of blood can be given back during or after the operation.

Disadvantages: Cannot use in cancer or infection. Not available everywhere. Rarely can cause allergic reactions or kidney failures.

Hemodilution

Option: Drawing some of patients’ blood right before surgery and replaced with fluids.

Explanation: The drawn blood is replaced by fluids making the total body blood less concentrated. The drawn blood is processed and kept aside.

Advantages: Lowers chances for need of donated transfusions. Dilutes the blood and so the blood lost during surgery is relatively decreased. If needed the blood donated previously can be returned.

Disadvantages: Limited number of units can be donated. Not all patients are candidates due to previous medical conditions. Decreases Oxygen carrying capacity of blood.

Volunteer donated blood

Option: From blood banks (supplied by American Red Cross or Hospitals).

Explanation: Blood collected in the community from volunteer donors.

Advantages: Almost always available in emergency cases or elective procedures.

Disadvantages: Has risk for disease transmission. AIDS 1 in 700,000, and Hepatitis 1 in 3000. Continuously improved numbers with better testing. Compare with risk of driving or walking across the street!!!

Designated Donor

Option: Blood Transfusion.

Explanation: Patient selects a donor (a relative or friend) Must meet the same rigorous requirements of a volunteer donor.

Advantages: Can select wife or husband or any other relative.

Disadvantages: Requires advance preparation 1-2 weeks. Risk of disease similar to Volunteer donated blood. Not necessarily as safe, nor safer, than volunteer donated blood.

Some points are important to remember. If blood is donated before the operation, the patient’s blood will be used first. However, if more blood transfusions are needed Volunteer donated blood must be used. When requesting a family member to donate blood, one should never pressure them to donate blood. They may have a disease not known to other family members and pressuring them to donate may create an unfavorable situation. If blood is donated by a family member, it may have to be irradiated to prevent certain biologic reactions. Always remember, the safest blood is your own, use it when possible. Other general consideration includes medical conditions such as lung and heart disorders. Elderly patients cannot tolerate low blood volumes compared with young healthy individuals with good heart function. So the threshold of transfusion is lower with elderly patients compared with young individuals.