Terry Hanna got something of an unwelcome surprise last year as he recovered from hip replacement surgery.
Hanna, 66, who has participated in masters swimming events and is an avid hiker, cross-country skier, scuba diver and snorkeler, was told that he was anemic.
“That kind of surprised me,” said Hanna, who lives in north Everett. “I’ve always thought of myself as a healthy guy, even with two bad hips.”
In the past, Hanna might have needed a blood transfusion, especially since he was low on red blood cells. That’s something routine in these surgeries.
Instead, Trudi Gallagher, a blood conservation coordinator at Providence Everett Medical Center, suggested giving him iron intravenously while he recovered in the hospital, and heavy doses of iron supplements after he left.
Hanna said he was amazed and delighted that there was a nurse who specialized in helping to conserve his blood, and, if possible, avoid transfusions.
Hanna said he thinks he is like most people in this era in preferring not to receive somebody else’s blood, even though he’s donated blood in the past.
The national move to conserve a patient’s own blood and reduce the number of transfusions began about 25 years ago, Gallagher said.
It came at a time when HIV and other blood-borne diseases were raising concerns about the safety of the nation’s blood supply.
Since then, strict screening and testing have greatly increased blood supply safety.
Yet periodic blood shortages and the rising costs of blood have led to greater efforts to conserve every drop during surgery and boost the body’s own production of red blood cells. The goal is to reduce the need for transfusions, Gallagher said.
At Providence Everett Medical Center, these efforts first began more than two years ago with cardiac patients, she said.
When Providence kicked off its blood conservation program in the fourth quarter of 2004, 66 percent of coronary bypass patients received a transfusion, said Dr. James Brevig, an Everett cardiovascular surgeon. By the fourth quarter of 2005, that number had dropped to 21.1 percent of patients, he said.
The cost of a pint of blood from the Puget Sound Blood Center runs about $140. By the time nursing, blood tests and equipment costs are added, the cost can hit $850, according to hospital estimates.
Avoiding unnecessary transfusions saves about $7,000 for each patient undergoing open heart surgery, Gallagher said.
“That is because of shorter length of stays, less time on the ventilator, less risk of infections and inflammatory responses and due to less cost of blood,” she said.
Yet the incentive for blood conservation isn’t just to save money, Brevig said. It’s to improve patient care.
The average length of time in the hospital for patients having open-heart surgery who didn’t receive transfusions was 3.9 days, Brevig said. For those who did get a transfusion, it was 6.3 days.
How much of that is because the patients who received transfusions may have been sicker to begin with? That’s impossible to know for sure, he said.
“It is quite clear from the medical literature that patients do better with fewer blood transfusions,” which can contribute to kidney, lung and inflammatory problems, he said.
“People are better off without it unless they really need it,” Brevig said.
Steps to conserve blood include boosting blood with vitamins, iron infusions or hormone treatments.
Efforts are under way to reduce the number and amount of blood samples taken from hospitalized patients, Gallagher said.
In the operating room, conserving blood can involve more meticulous surgical work by physicians. Machines may be used to cleanse and give back a portion of a patient’s red blood cells that normally would have been lost during surgery. And a new cauterizing device that reduces blood loss is available.
“It’s a whole program. It’s not just in the operating room,” Brevig said. “It has to do with total patient care.”
Although conservation is in vogue for everything from energy to oil, blood conservation is not controversy-free.
“My concern would be swinging the pendulum too far in the direction of not transfusing when perhaps a patient might actually need it,” said Dr. Terry Gernsheimer, director of medical education at the Puget Sound Blood Center in Seattle.
“I think it’s very important for a patient to understand how very safe the blood supply is and the amount of testing we do.”
Sometimes, blood conservation has been used for marketing efforts by hospitals, she said.
“Physicians are hopefully not transfusing more than necessary, anyway,” Gernsheimer said.
Mary Ghiglione, who oversees the blood management department at Swedish Medical Center in Seattle, said the blood conservation movement is growing, not only in Washington, but nationally.
“We actually did a national webcast,” she said. “The response has been awesome.”
The hospital started the program in 2005 and decreased its blood usage by 2,000 units, or pints, over the previous year, Ghiglione said. During 2006, there was another drop of 2,000 pints.
Since the start of the program, estimated savings for the purchase of blood exceed $2 million, she said.
Dr. Clay Wertheimer is one of several Everett orthopedic surgeons trying the blood-saving techniques.
In the past, it wasn’t uncommon for a patient to receive one to two pints of blood following a knee or hip replacement surgery, he said.
Over the past six months, “I can’t remember the last time on a routine total knee or hip (joint replacement surgery) that I’ve had to transfuse,” Wertheimer said.
Not only are transfusions expensive, he said, but there is growing evidence that a blood transfusion “is not completely benign,” temporarily affecting the body’s ability to heal and fight infection.
“We never promise that we won’t transfuse them,” Wertheimer said. “I would want the ability to provide someone with a blood transfusion if it meant life or death.”
Nevertheless, the prospect of surgery without a transfusion “is appealing to patients,” he said.
Reporter Sharon Salyer: 425-339-3486 or salyer@heraldnet.com.
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