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Increasing patient safety through blood management

Toronto, October 4, 2013

By Patricia Favre

Dr. Katerina Pavenski holds a unit of red blood cells.
Dr. Katerina Pavenski holds a unit of red blood cells. (Photo by Katherine Cooper)

Doctors at St. Michael’s Hospital are leading a charge to significantly reduce the use of blood transfusions – which may be one of the most overused procedures in modern medicine.

Recent literature indicates that up to half of transfusions are prescribed for no justifiable reason.

Transfused patients often have higher infection rates, poorer wound healing, increased morbidity and mortality – and longer hospital stays, driving up costs.

Last year, St. Michael’s created a Centre of Excellence for Patient Blood Management, the first of its kind in Canada and a global leader in patient care and training and educating health care professionals.

That work is becoming more important as Canada’s population ages, increasing the demand for transfusions. The centre is hosting an international symposium on patient blood management on Oct. 26 at the Li Ka Shing Knowledge Institute in Toronto.

In 1998, St. Michael’s became one of the first hospitals in Canada to implement a blood conservation program.

The Ontario Transfusion Coordinators, or ONTraC, program, funded by the Ontario Ministry of Health and administered through St. Michael’s, sets the standard in the province for patient blood management.

The results have been remarkable. In 2002, nearly a quarter of Ontario knee surgery patients received a transfusion. In 2012, just 6.6 per cent of knee surgery patients received transfusions, with the infection rate in transfused patients of 1.7 per cent dropping to 1.1 per cent in non-transfused patients.

Coronary artery bypass grafting surgeries have similarly seen a 55.5 percent drop in transfusions, with an infection rate of 10.5 per cent in transfused patients versus 3.4 per cent in those not transfused.

Those types of results have also meant significant cost savings to the province. In 2011, ONTraC’s budget was $3.2 million, resulting in $10.5 million in blood unit purchase savings alone and overall savings of almost $40 million.

St. Michael’s physicians emphasize that reducing blood transfusions requires action before and during surgery.

“Physicians might prescribe certain drugs or dietary supplements to raise a patient’s hemoglobin level before surgery,” said Dr. John Freedman, former director of transfusion medicine at St. Michael’s Hospital. “During surgery, we have a variety of state-of-the-art technologies and techniques to minimize blood loss.”

Those techniques include minimally invasive surgery, an argon beam coagulator that clots blood to minimize blood loss, and electrocautery – using heat to stop vessels from bleeding.

Dr. Katerina Pavenski, head of the Division of Transfusion Medicine at St. Michael’s, emphasized the importance of pre-surgery intervention.

“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?” she said. “Anemia, or 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 should strive to diagnose and treat anemia well in advance of surgery so we can have the patient in the best shape for surgery.”

Dr. Freedman said patient blood management also creates better outcomes for patients who object to receiving blood or blood products as part of their medical treatment, including patients with health care concerns, or religious concerns such as Jehovah’s Witnesses.

In July, a team of researchers at St. Michael’s led by Dr. David Mazer was awarded a Canadian Institutes of Health Research grant to determine the optimal transfusion threshold in patients undergoing cardiac surgery. Worth $3.3 million over 4-1/2 years, it was the largest CIHR grant in that grant cycle.

The study will involve over 3000 patients from 40 cardiac centres around the world.

“This grant is the culmination of over a decade of research and hard work by all members of our department,” said Dr. Mazer. “I’m proud that St. Michael’s Department of Anesthesia will be seen as the leader of this important international study.”

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 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, 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.