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St. Michael’s to create centre for patient blood management

Toronto, September 13, 2012

By Leslie Shepherd

Patient blood management - blood bags
Photo courtesy Canadian Blood Services

It used to be that giving a patient a blood transfusion was a good thing. Now the paradigm has shifted, says Dr. John Freedman, director of transfusion medicine, and transfusions are to be avoided unless absolutely necessary.

The goal now is to strive toward “bloodless medicine.”

In 1998, St. Michael’s became one of the first hospitals in Canada to implement a blood conservation program. The Ontario Transfusion Coordinators (ONTraC) program administered through St. Michael’s sets the standard in the province for patient blood management.

Now St. Michael’s plans to develop a Centre of Excellence for Patient Blood Management, which Dr. Freedman says would be the first of its kind in Canada and a global leader in patient care and in training and educating health care professionals.

The centre plans to host an international symposium on patient blood management on Sept. 15 (Saturday) at the Li Ka Shing Knowledge Institute.

Dr. Freedman said the goal of patient blood management is to reduce the many risks associated with blood transfusions, improve patient outcomes and respect patients who object to receiving blood or blood products as part of their medical treatment, such as Jehovah's Witnesses. There is strong scientific evidence that patients who avoid transfusions have fewer complications, faster recoveries and shorter hospital stays.

It also makes good sense economically.

The average cost of transfusing one unit of blood is $1,200. Recent literature indicates that up to 50 per cent of transfusions are prescribed for no justifiable reason. Ontario alone transfuses more than 400,000 units of red cells a year. As the population ages, the demand for blood will outstrip the supply.

Under patient blood management, physicians might prescribe certain drugs or dietary supplements to raise a patient’s hemoglobin level before surgery.

During surgery, doctors may use a variety of state of-the-art technologies and techniques to minimize blood loss, such as minimally invasive surgery, electrocautery (using heat to stop vessels from bleeding), an argon beam coagulator, which coagulates or clots blood to minimize blood loss, or intravenous iron and erythropoietin, which stimulate bone marrow to produce red blood cells.

“My advice to patients who are being considered for surgery is to ask a question: what is my hemoglobin? What can I do to make myself better prepared for surgery?” said Dr. Katerina Pavenski, head of the Division of Transfusion Medicine.

“General interventions like stopping smoking or losing extra weight may reduce post-surgical complications and are routinely recommended by family physicians and anesthesiologists. Anemia (low hemoglobin) is associated with a number of complications and increased risk of requiring a transfusion in the post-operative period, yet it is not currently getting much attention. We frequently get patients with significant anemia with only days left before the scheduled surgery. We should strive to diagnose and treat anemia well in advance of surgery so we can have the patient in the best shape for surgery.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.