Peri-operative Blood Conservation Program

Introduction
Anemia
Frequent Asked Questions
Helpful Links
Contact

Introduction

Southlake’s Peri-operative Blood Conservation Program is part of the Ontario Nurse Transfusion Coordinators Program (ONTraC), which is funded by the Ministry of Health and Long-Term Care.

The goal of the ONTraC Program is to enhance blood transfusion practices by promoting alternatives to blood transfusion in surgical patients, and improving patient care and well-being in a cost-effective manner.

At Southlake, the Peri-operative Blood Conservation Program aims to:

• decrease the need for blood transfusion during scheduled or elective surgery;
• promote alternatives to allogeneic (donor) blood transfusion in surgical patients;
• educate patients and their families, physicians, and staff about the benefits and risks of blood transfusion.

Currently, Southlake is one of 25 centres throughout Ontario with a Blood Conservation Coordinator.

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Anemia

• poor diet;
• shortage of iron, vitamin B12, or folic acid in your diet;
• blood loss, such as during menstruation or surgery, or from a bleeding ulcer;
• medications which interfere with your body’s ability to produce red blood cells.

Other types of anemia are chronic and may last for a long time. The causes of chronic anemia can include the following:

• cancer and cancer treatment
• chronic diseases, such as kidney failure or severe arthritis
• inherited blood disorders

How do I know if I am anemic?
The only way for a person to know if he/she is anemic is to have a blood test to check the red blood cell and hemoglobin levels. 

How is anemia treated?        
Treatment for anemia depends on the cause. If a person has too little iron, vitamin B12, or folic acid to make red blood cells work effectively, a change of diet and use of specific vitamins and/or iron pills may be recommended. In some cases, injections of a medication that will increase production of red blood cells may be used.

Why is anemia a risk in surgery?
If you lose too much blood during surgery, your organs and tissues may not get enough of the oxygen they need to do their work. As a result, you may not respond well to surgery and your recovery might be delayed.

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Frequently Asked Questions

Who should participate in the Blood Conservation Program?
What approach is taken by the Blood Conservation Program at Southlake?
What role do physicians play in treating blood loss during surgery?
What is a blood transfusion?
Where do blood and/or blood products come from?
Can I refuse a transfusion?
Can I donate my own blood?
Can I donate blood for a family member?
What are the risks of having a blood transfusion?
What are the risks of not having a blood transfusion?

Who should participate in the Blood Conservation Program?
Patients may benefit from blood conservation strategies, if:

• they are scheduled for surgery which is commonly associated with high blood loss;
• they have a low hemoglobin count when they come to the Pre-op Clinic;
• their body weight is under 55 kg;
• they refuse blood and/or blood products for religious or other reasons.

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What approach is taken by the Blood Conservation Program at Southlake?

• Patients at risk for transfusion are identified ahead of surgery and seen in the Pre-op clinic 3-5 weeks before surgery, whenever possible.
• Informed consent and alternatives to transfusion are discussed.
• Diagnosis, investigation, and treatment of anemia are carried out by physicians (e.g., family doctor, surgeon, anaesthesiologist, hematologist).
• If appropriate for patient, medications may be prescribed to increase the hemoglobin count.
• If appropriate, patients may be able to pre-donate their own blood. This may not be appropriate for every patient or for every type of procedure.

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What role do physicians play in blood conservation during surgery?
Our doctors take every precaution to reduce the amount of blood loss that occurs during surgery.  Strategies that may be used during surgery include:

• positioning of the body
• use of certain medications to reduce blood loss in surgery
• non-blood fluids administered intravenously
• certain types of anesthesia
• collect and return blood
• special surgical techniques
• special surgical tools to reduce blood loss

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What is a blood transfusion?
A blood transfusion is a medical procedure whereby blood or blood products are infused intravenously into a person’s vein. The two most common reasons for blood transfusions are to replace blood lost as the result of an accident or operation, or  to treat a lack of red blood cells.

It is normal for some blood to be lost during certain operations. A small amount of blood can be replaced by a liquid with different types of salts or sugars in it. If a large amount of blood is lost, the doctor may decide that a blood transfusion is needed.

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Where do blood and/or blood products come from?
In Canada, Canadian Blood Services collects and tests blood from volunteer donors. This donated blood is tested for several infectious diseases, including syphilis, Hepatitis B and C, HIV, and several other viruses that can be transmitted through blood, including the West Nile Virus. 

Blood that is free of viruses is distributed to hospitals. Some products, such as those given to pregnant women (RHO D immunoglobulin), immune globulin(s), or varicella-zoster serum, are purchased from pharmaceutical companies which follow very strict quality control guidelines.

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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 your religious beliefs, you must inform your doctor. However, there are risks associated with your refusal and all patients are encouraged to speak with their doctor before making this decision.

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Can I donate my own blood?
Pre-donating your own blood, known as autologous donation, or donating for a child under the age of 16 years of age, known as directed donation, are two options for people who are interested in donating their own blood. Certain requirements must be met in order to select either of these two options. Patients are encouraged to speak with their doctor about these options. Most doctors will work to avoid a blood transfusion, even if a patient’s own blood is used.

If you donate your own blood for your surgery and it is not used, it will be disposed of when you are discharged. Autologous blood does not undergo the same stringent testing that allogeneic (donor) blood does and therefore cannot be used by the general population.

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Can I donate blood for my family member?
At present, Canadian Blood Services does not allow family members to donate blood for another family member unless they are a parent donating for their child under 16 years of age.

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What are the risks of having a blood transfusion?
Blood is a living tissue and so there will always be some reaction while your body accepts this new tissue. Some reactions include:

• Allergic reactions – Common but usually mild and easy to treat. Patients may experience chills, rash, hives, muscle aches, or headaches.
• Fever – This is most common for patients who have had a previous transfusion or are pregnant.
• Hemolytic reactions – These types of reactions are rare but can be serious. The reaction occurs when the patient receives blood that does not match his/her blood type. These reactions can be prevented by careful blood collection, testing, preparation, and administration, and by careful attention to identification procedures to ensure the correct blood is given.
• Transmissible infections – All donor blood is carefully tested for infectious diseases. Although the risk of getting a disease or infection is small, the risk cannot be completely removed with the available testing.

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What are the risks of not having a blood transfusion?
A doctor will carefully weigh the benefits and risks before ordering a blood transfusion. In order for you to make an informed decision about whether or not you wish to have a transfusion, you (or your substitute decision-maker) must also understand the benefits and risks.

If you lose a large amount of red blood cells, your body will not get enough oxygen. Without enough oxygen, there is the risk of damage to vital organs, such as the brain and heart. When used appropriately, blood transfusion can save lives.

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Helpful links

Ontario Nurse Transfusion Coordinators Program
http://transfusionontario.org/en/ontrack_home.php

Ontario Regional Blood Coordinating Network
http://www.transfusionontario.org/en/orbcon_home.php

Canadian Blood Services
www.bloodservices.ca

Anemia Institute
www.anemiainstitute.org

Contact

For more information about Southlake’s Peri-operative Blood Conservation Program, please call the Blood Conservation Coordinator at (905) 895-4521, extension 2909.

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