Recycling Trauma Patients' Own Blood Can Be Beneficial

< Jul. 21, 2010 > -- New research published this week suggests that transfusion with a trauma patient's own blood may offer a cost-effective and safer alternative to transfusion with blood from another individual as a resuscitation method during surgery.

The study is published in the Archives of Surgery.

During planned surgeries in which the patient is expected to experience significant bleeding into the chest cavity or abdomen, it is common practice for doctors to suction patients' blood, which is then collected in a canister, filtered, and returned to the patient, researchers said.

While reusing the patient's own blood is possible, it is much less common during emergency surgeries that can occur after shootings, car accidents, and other traumas, explains study author Dr. Carlos Brown, medical director of trauma services at University Medical Center Brackenridge in Austin, Texas. That is because of the need to have a perfusionist or other specially trained member of the surgical team on hand to operate the necessary equipment and oversee the procedure.

Fewer Risks, Lower Costs

If more trauma centers would do reuse patients' blood, it would both lower costs and potentially avoid blood-transfusion related risks to trauma patients, including reactions to the donated blood and the transmission of infectious disease, says Dr. Brown.

In addition, the patients' own blood is "fresher," he says. Over time, blood stored in blood banks deteriorates and may not flow as well through the body.

"Normally when you are in the operating room doing surgery for trauma, the blood [lost by the patient] gets discarded," notes Dr. Brown. "By setting up a 'cell salvage system', we can give the patients' own blood back to them. It's safer and costs less than getting blood from the blood bank."

Receiving Own Blood Reduces Amount Needed and Costs

Injury from trauma remains the leading cause of death for people aged 1 to 44, according to background information in the study.

According to the study authors, "[T]ransfusion of allogeneic [from another individual] blood products in trauma patients has been independently associated with increased morbidity and mortality, particularly when transfusing older, stored blood products."

Blood loss plays a major role in as many as half of these deaths, especially for deaths that occur in the operating room or within the first 24 hours after injury. Patients who go into shock because they are hemorrhaging blood require transfusions, sometimes "massive" ones, according to the researchers.

Dr. Brown's team matched 47 patients undergoing emergency surgery who received their own blood with 47 people who received blood from blood banks. Patients were matched for age, gender, injury severity, type of injury, and surgery.

The patients who received their own red blood cells and plasma still needed some blood from donors, but only about half as much blood as the others, according to the study.

Requiring less blood helped bring the average cost down, from $2,584 for patients who received blood from a blood bank to $1,616 for those who received their own blood.

"In trauma, things move quickly and there is not as much time for preoperative planning," says Dr. Brown. "We just want to get the message out that if you can do this at your trauma center, you should."

Process Needs More Utilization, Say Experts

Dr. Jonathan Waters, chief of anesthesiology at McGee Women's Hospital in Pittsburgh and medical director for the blood management program, says researchers are right to push for greater usage of "cell salvage."

"It's way underutilized," he says. "As medicine comes to realize the dangers of blood from somebody else, it will be utilized more and more. There is a litany of bad things that can happen with allogenic blood. If you can provide something at a lesser price and it's better for the patient, you have a no-brainer."

Though there was no difference in patient outcomes between the two groups in Dr. Brown's study, prior research has shown that blood transfusions using donor blood are associated with an increased risk of death, independent of other factors.

Reusing the patient's own blood also has the potential to help alleviate blood shortages, Dr. Brown says.

Always consult your physician for more information.

More About Blood Transfusions

There are several different components of the blood that can be transfused into an adult. Red blood cells are the most common type of blood product transfusion. If your physician has decided you might need a transfusion of blood, or blood products, he/she will explain the reasons for the transfusion. There are several reasons why you may require a blood transfusion, including the following:

• a sudden loss of blood (sometimes as high as a quarter of the normal blood volume)
• a low hemoglobin before, during, or after surgery
• severe heart or lung disease
• bone marrow failure
• moderate to severe anemia

The blood used at most hospitals is from volunteer donors. Donors are not paid for giving blood or blood products. Each blood donor must answer medical history questions and be given a limited physical examination before being accepted as a donor. The donated blood is carefully tested for hepatitis viruses B and C, human immunodeficiency virus (HIV), human T-lymphotrophic viruses (HTLV) I and II, syphilis, and West Nile virus. These tests decrease the chances of transfusion-related infections.

Blood is collected and stored in sterile bags. The bags are used once and then thrown away. Before blood is given to you, it is crossmatched with your own blood to make sure it is compatible. The blood will be given through a needle or catheter placed in the vein. Your temperature, blood pressure, and heart rate will be checked many times while the blood is being given. It may take a few hours to complete the process.

A directed (or designated) blood donation is one in which a person donates blood that is reserved (at the time of donation) for the transfusion of a specific patient at a later date. The donor is usually a family member or a close friend that has been chosen by the patient's family. Consult your physician if you are interested in learning more about directed donation. It is recommended that families donate in a particular person’s name versus directed donation, because if directed blood is not needed, it is wasted.

There is no proof that directed donors are safer than volunteer donors. Many directed donors have never donated blood before, and so, have not been proven (by repeated donations) to be free of infectious agents. Not all directed donor blood will be compatible with the patient’s blood.

Most transfusions are performed without any problems. Mild side effects may include symptoms of an allergic reaction such as headache, fever, itching, increased breathing effort, or rash. This type of reaction can usually be treated with medication, should you require additional transfusions. Serious reactions are rare. The most common serious side effect is serum hepatitis, an infection of the liver. Transfusion with blood of the wrong type can be fatal, but this is highly unlikely to occur.

Always consult your physician for more information.