20 April 2003

Are we using too much blood?

Diseases like CJD and a general decline in donations mean that our blood reserves are under severe threat. However, some experts believe that blood transfusions are not always necessary, and using less blood may even be better for the long term health of many patients. The issues will be debated at the Royal Society of Medicine's Sensible Use of Blood conference on 30th April, including:

"Blood-free" surgery is no longer fiction
Dr David Royston, Harefield Hospital, - Haemostatic agents
Preventing transfusion of donor blood is more important than preventing bleeding alone. Although blood transfusion can be life saving this is not always the case. A "growing body of evidence" links blood transfusions with extra health problems for many patients, claims Dr Royston. As well as the risk of hospital infections and blood-borne diseases, evidence has also been found that having a transfusion of someone else's blood increases risk of a cancer relapse. Dr Royston argues that in many cases, even in major surgery, there are drug therapies that contribute to ensure no need for any transfusions. Preliminary data shows that with one of these drugs gullet cancer relapse risk is reduced fivefold.

Is less blood really better?
Professor Jeffrey Carson, New Brunswick, Jersey, US, - Critical haemocrits
The idea that 'less blood is better' is taking time to catch on in hospitals both in the UK and the US. Professor Carson suggests that we do not yet have enough evidence to settle the controversy over when to transfuse. This could change with a major new clinical trial which he and his colleagues expect to begin later this year. Professor Carson will discuss what he hopes to learn from this trial (involving elderly patients with cardiovascular disease undergoing emergency surgery), and about what he has already learnt from his work with people who refuse blood transfusions for religious reasons.

Washing blood and using it again
Mr John Thompson, Exeter, - Cell Salvage
For Mr Thompson's surgical team transfusion-free operations are already a reality, even for major blood vessel surgery. He will describe the recycling techniques used at Exeter in which a patient's own blood, instead of being lost during an operation, is sucked into a machine to be cleaned and put back into the patient there and then. The cost for the entire operation is roughly equivalent to the cost of supplying just one pint of donated blood. Exeter is unique in having a doctor (Dr Biddy Ridler) as Clinical Blood Conservation Coordinator to oversee best practice across departments.

Diluting an armful of blood to go a long way
Dr Michael Nevin, Bristol Royal Infirmary, - Isovolaemic haemodilution
One way of coping with the rising costs of screening and storing blood is to for patients to donate their own blood just before an operation. Doctors can then dilute the blood in the patient's body with other fluids, a technique which can actually improve the outcome of surgery. Getting your own blood back again at the end of the operation greatly reduces the risk of infection and screening errors, and means that you get the advantages of fresh blood rather than the stored product. Dr Nevin will describe the practical issues surrounding this method, which has been proven at Bristol to have saved money year on year as well as benefitting patients.

Changing surgical techniques to reduce blood loss
Professor Gianni Angelini, Bristol University, - Avoidance of cardiopulmonary bypass
Professor Angelini was one of the first people in the UK to popularise 'beating heart' surgery. This technique, which was developed to avoid lengthy and dangerous heart-and-lung bypasses, has a number of advantages, among them the fact that it "significantly reduces" blood loss after the operation, and so reduces the need for transfusions. Professor Angelini will discuss his recent research and explain why he thinks it is so important for this kind of surgery to become available across the UK.

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