Patients Donate Blood Minutes, Not Days, Before Surgery

You’re asleep in the operating room and just about to have your prostate removed. Is this a good time to give up perhaps 40% of your blood, before the operation even starts?

Yes, say doctors who give such donations back to patients during surgery.

For a variety of operations, experts say, the technique provides an alternative to the usual way people set aside their blood for elective surgery, which is to donate repeatedly at a blood bank in the weeks before the operation.

The last-minute technique, called hemodilution, can eliminate the inconvenience of weekly donations, save money and provide better-working blood for transfusion when patients go under the knife, they say.

While the technique is widely used in Europe, “it has not really caught on as much in this country” outside of heart surgery because many surgeons and anesthesiologists are unfamiliar with it, says anesthesiologist Dr. Terri Monk of the Washington University School of Medicine in St. Louis.

Her department has used hemodilution routinely in urological surgery for two years and plans to expand it to other types in the next year or so, she said.

Hemodilution makes sense for many heart surgeries and procedures that can involve substantial blood loss, such as major surgery of the spine or kidney, so-called radical prostate removal, operations within the abdomen and some hip replacements, said Dr. Linda Stehling, vice president for medical affairs of Blood Systems Inc. in Scottsdale, Ariz.

People interested in having the technique done should discuss it with their surgeons, she said. Hemodilution is done at many academic medical centers but its use is limited elsewhere.

At Washington University, the blood is usually collected just after the patient falls asleep from anesthesia. Anesthesiologists collect up to four units--about four pints--which is around 40% of the blood of a 150-pound person.

At the same time, they give the patient intravenous fluid so the total fluid volume in the veins and arteries remains normal. That prevents shock. Despite this dilution, the patient has enough red blood cells to carry oxygen around the body.

As surgery proceeds, the withdrawn blood is returned to the patient as needed to keep the red cell supply up. Generally, all the blood is returned, so some patients also donate a unit of blood before surgery in case they need some more after leaving the operating room. Fresh blood from hemodilution also does better at carrying oxygen and stopping post-surgical bleeding than stored blood.