Perioperative Blood Management Service (PBMS)

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1 2014 Perioperative Blood Management Service (PBMS)

2 Perioperative Blood Management Service (PBMS) Purpose The purpose of the perioperative blood management service is: To decrease and/or eliminate the need for blood transfusion during planned surgery. To educate patients about the risks and benefits of blood transfusions and other blood alternatives. 1

3 What is normally in the blood? Blood contains red blood cells, white blood cells, and platelets floating in a liquid called plasma. Red blood cells contain hemoglobin, which carries oxygen to all tissues of the body. White blood cells fight infection. Plasma contains many factors including those needed for clotting. Platelets are also involved in the prevention of bleeding. Components of blood Water: 50% White blood cells and platelets: 1% Red blood cells: 43% Plasma: 5% 2

4 What is a blood transfusion? A transfusion is when you receive a blood component or product through an intravenous (IV) tube in your arm. A blood component is made when donor blood is separated into different parts. Some examples of these blood components are: Red blood cells Platelets Plasma Cryoprecipitate Blood products Albumin Clotting factors Where does the blood for a transfusion come from? Blood is collected from healthy volunteer donors at Canadian Blood Services. Each time blood is donated it is tested for syphilis, hepatitis B, hepatitis C, HIV, and other viruses. Blood is NOT used for transfusion if there is any concern it may transmit disease. In an emergency, your doctor will decide whether to transfuse and what type of blood product to use. 3

5 Informed consent If your doctor prescribes a blood transfusion of blood components or products for you, he or she will explain the benefits and risks of the transfusion, and ask you to sign a consent form for the treatment. These risks and benefits will differ depending on what component or product you are to receive, and on your illness or condition. If you have any questions or if there is anything that you don t understand, ask your doctor before signing the consent form. Frequently asked questions about blood transfusions: Why are transfusions needed? To increase red blood cells, which increases the oxygen circulating in your blood. To replace clotting factor or platelets in your blood to help stop bleeding. To replace blood loss due to trauma or injury. To replace blood loss caused by a treatment or a procedure that may cause your blood cells to be lower for a time. 4

6 What are the risks of a blood transfusion? For each blood component received, the current risk of some viral infections is estimated to be: 1 in 7,800,000 for HIV 1 in 153,000 for hepatitis B (liver infection) 1 in 2,300,000 for hepatitis C (liver infection) Less than 1 in 1,000,000 for West Nile (very low risk) The current risk of some non-viral infections is estimated to be: 1 in 100 for minor allergic reactions 1 in 300 for febrile (increased temperature reactions) 1 in 50,000 for bacterial contamination 1 in 7,000 for delayed hemolysis (hemolysis is when your red cells are destroyed) 5

7 Receiving blood components or products in Canada is very safe. Serious complications are rare but may be life-threatening. These reactions may be mild or severe: Severe allergic reaction Human error Bacterial contamination Transfusion-Related Acute Lung Injury (an immune reaction that affects a person s lungs) Less ability to fight infections for a time Fluid overload Source: Callum, et al. (2011). Bloody easy 3: blood transfusion, blood alternatives and transfusion reactions. 3rd ed. ORBCON. The risks of getting sick due to a transfusion are very small. Blood can never be completely risk-free. Please talk with your doctor if the risks associated with having a blood transfusion are higher than the possible result of not receiving a transfusion. In an emergency, your doctor will decide whether to transfuse and what type of blood component or product to use. 6

8 What are the alternatives to receiving donated blood? There are several options for patients that can be used to decrease or eliminate the need for a blood transfusion, but not all are appropriate for every individual. No transfusion The health risks from not having a transfusion when needed are much greater than from having a transfusion. Many types of surgery and treatments for cancer are usually not possible without transfusions of blood components or products. If you need elective surgery (your surgery is scheduled well in advance), your surgeon, the Perioperative Blood Management Service, and your family doctor will work together to ensure that you are as healthy as possible. When getting ready for an operation, the need for blood transfusion can be decreased or avoided by careful planning. Using blood management strategies does not rule out the possibility of needing a blood transfusion. The stronger that you are going into surgery, the less likely it is that you will need a blood transfusion. 7

9 Preoperative period (in the weeks before surgery) If there is time, certain types of anemia (blood deficiency) may be corrected by medication: Medications may include: Iron therapy Vitamin B12 Folate (Folic acid) Erythropoietin (to stimulate red cell production in your body) Donating your own blood (autologous donation) You may be able to donate your own blood for future use when surgery is planned and not urgent. Depending on your condition, this must be arranged by your doctor well before your surgery. Can I donate for a family member or friend? This is called a directed donation (donation for a specific person). Currently in Nova Scotia, parents who are eligible may provide their blood for their children. This must be arranged through your doctor and Canadian Blood Services and is not available in emergency situations. Usually these donations happen 4-6 weeks before a pre-booked surgery. Directed donations, like autologous donations, are only used for the specific patient. They cannot be given to others. 8

10 Intra-operative period (during surgery) some words your doctor/nurse may use: Antifibrinolytic drugs: drugs that help blood to clot. Pediatric sampling: a smaller than usual amount of blood is withdrawn from the patient for laboratory testing. Acute Normovolemic Hemodilution (ANH): a patient s blood is withdrawn at the beginning of surgery and replaced with intravenous solutions (a salt solution). This is called hemo-dilution because the saline dilutes the patient s blood. The blood that was removed is stored in the operating room with the patient. If the patient bleeds, the anesthesiologist returns their own blood back to him or her. Fibrin sealant (glue). Pulse oximetry: tracks oxygen levels during surgery. Volume expanders: non-blood fluids given by IV to increase blood volume. 9

11 Hypotensive anesthesia: lowers blood pressure so blood is less likely to leak. Hypothermia: lowering your body temperature to decrease oxygen consumption. Cell saver (blood salvage): depending on your condition, blood lost during surgery can be recycled and returned to you. This must be arranged by your doctor before your planned surgery. Electrosurgical and ultrasonic harmonic scalpel coagulators: coagulates (clots) a patient s blood during surgery to reduce blood loss. Laser surgical techniques: uses laser light to remove diseased tissues or treat bleeding blood vessels. Endoscopic and laparoscopic surgery: surgery is done through a surgical tube so there is a smaller incision (cut). These options may be available to surgery patients, but not all are right for every individual. 10

12 Does artificial blood exist? No. Most often when people think about artificial blood, they imagine something that doesn t contain any blood, but still carries oxygen throughout the body. Scientists haven t yet been able to design a product like that. There are products called blood substitutes but they are NOT licensed for clinical use (not licensed to be given to patients) in either Canada or the United States. 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 religious beliefs, you must tell your doctor. However, there are risks associated with refusal. Ask your doctor. Your doctor will be able to give you more information about these choices. If you have any questions, please call (902) or visit our website or 11

13 If you have any questions, please ask. We are here to help you. Notes: 12

14 Notes:

15 Looking for more health information? Contact your local public library for books, videos, magazines, and other resources. For more information go to Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia Prepared by: Perioperative Blood Management Service Illustration by: LifeART Super Anatomy 5 Images, Copyright 1994, TechPool Studios Corp. USA Designed by: Capital Health Library Services, Patient Education Team Printed by: Dalhousie University Print Centre The information in this brochure is provided for informational and educational purposes only. The information is not intended to be and does not constitute healthcare or medical advice. If you have any questions, please ask your healthcare provider. WH Revised August 2014 The information in this pamphlet is to be updated every 3 years.

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