Joseph A. Oxendine, MD
Assistant Attending Anesthesiologist, Hospital for Special Surgery
Clinical Instructor of Anesthesiology, Weill Cornell Medical College
At HSS, we are committed to developing and using the latest advanced techniques and technology to reduce and/or eliminate the need for use of blood transfusions in treating our patients. Although the nation's blood supply is considered very safe, it is impossible to completely eliminate the possibility of transmitting blood borne infections, allergic transfusion reactions, or mislabeled or mishandled donated blood. In addition, National Blood Bank stores are low and every effort should be made to limit the use of these scarce blood products. Thus, HSS has developed an integrated Blood Management Program. A summary of some of the important procedures implemented as part of the Blood Management Program follows.
Whenever patients are scheduled for elective surgery where moderate or larger blood loss is expected, patients are encouraged to donate their own blood, if possible, prior to surgery. The patient’s own blood will then be used to replace blood loss as a result of the surgery.
Intraoperative Autologous Blood Recovery Systems, often called “cell saver machines”, have revolutionized blood conservation since their invention nearly thirty years ago. Cell saver machines are commonly used during operations when significant blood loss is expected, such as spine surgery. These machines collect blood lost during the operation, filtering and washing it so that it may be given back to the patient. At HSS, we also use a smaller version of this machine called the “OrthoPat” for some joint replacements/revisions during the perioperative period.
HSS has been at the forefront of using controlled hypotension to limit intraoperative blood loss. With this technique, the anesthesiologist, under careful monitoring, slowly and carefully lowers the patient’s blood pressure to a set point. Usually, this set point is a certain percentage below the patient’s baseline blood pressure and is determined based on his/her medical condition. The patient’s decreased blood pressure limits intraoperative bleeding and has the added benefit of providing a better surgical field for the surgeon.
Erythropoietin is a drug that can be given preoperatively to stimulate the body to increase its production of red blood cells, which are a major and essential component of blood. This drug is especially useful for patients who are anemic (i.e., have a low red blood cell count) preoperatively.
HSS is a world leader in the development of minimally invasive orthopedic surgical techniques. In addition to facilitating a shorter surgical recovery period, these techniques also, on average, have shown a decrease in surgical blood loss.
Tourniquets are one of the oldest blood conservation devices and are often used for surgical procedures involving the extremities such as foot/ankle, knee, hand, and elbow surgeries. A tourniquet is much like a common blood pressue cuff and is placed on the operative limb and inflated. The inflated pressure is sufficient to prevent blood flow beyond the tourniquet, thus minimizing blood loss and providing a relatively bloodless surgical field.
Crystalloids and colloids are commonly-used fluids used to expand intravascular volume after mild blood loss. These agents are used during every operation but are only effective for replacing small to moderate blood loss. This is just an overview of some of the blood conservation techniques utilized at HSS. Other techniques include electrocautery, platelet gel, fibrin glue, and aminocaproic acid. In fact, HSS is a leader in developing and incorporating into practice the latest blood conservation techniques. If you have any questions about blood conservation and your surgery, please speak to your health care provider.