MANY HEALTHY RETURNS In an effort to reduce transfusions, EMMC initiates measure to recycle and reintroduce the blood a patient loses during surgery

Up to his gloved wrists in his patient’s glistening chest cavity, heart surgeon Robert Clough paused to take in the familiar operating room scene around him. A team of nine nurses, surgeons, anesthesiologists and other specialists occupied their respective posts amid the banks of pumps and monitors that crowded the brightly lit room.

Overhead, the sound system crooned a moody Christmas song.

Surgery is a bloody business, but hospitals across the country, including Eastern Maine Medical Center, in Bangor are taking steps to minimize the blood lost during operations, and to return as much as possible to the patient. Other measures aim to build patients’ blood health before surgery, improving their ability to tolerate some blood loss. The overarching goal is to reduce the need for blood transfusions.

On Wednesday morning, blood from Clough’s deeply anesthetized patient coursed in several directions through a maze of plastic tubing in an operating room at EMMC. The majority flowed in a thick, red ribbon through the heart-lung machine, where it was mixed with a nonblood “volume expander,” saturated with oxygen and pumped back into the 79-year-old patient’s circulatory system to keep her organs and tissues healthy during the several hours it would take Clough to repair a leaky valve in her heart.

More blood snaked through a narrow catheter from her jugular vein to fill a plastic donor bag, ready to be given back to the patient when the procedure was over. And, vacuumed along with salt solution used to rinse the chest cavity so Clough could see clearly the slick contours of the heart, blood churned and stuttered through suction tubing to a transparent canister attached to a Cell Saver machine, one of several in use at EMMC. There it would be filtered, centrifuged and returned to the patient in a concentrated blast of iron-rich red blood cells.

“There is blood all over the place,” Clough said with professional zeal, “but none of it is going anywhere except right back into this patient.” Even the gauze sponges and cotton towels used to wipe up stray drops and spatters, he pointed out, would be processed to recover the blood they contain.

EMMC is the first hospital in Maine to formalize a “blood conservation and management program,” according to Dr. Irwin Gross, a pathologist and the medical director of transfusion services at EMMC. Although certain elements of the program have been in use in the cardiac surgery suite for some time, for the past year Gross has been working with health care providers throughout the hospital to change the way they think about transfusion.

Historically, transfusion has been viewed as a safe, life-saving treatment for patients who have lost a quantity of blood from surgery or trauma, he said in a recent interview. It also has been used to boost the blood’s ability to carry oxygen, critical to cell life and health.

But recent studies have shown that the potential benefits of blood transfusion come at a high cost, Gross said.

Although the donated blood supply is now rigorously screened for the presence of germs that can cause diseases such as hepatitis or AIDS, Gross said there are other reasons to avoid transfusion.

For example, blood transfusion temporarily suppresses immunity, so the patient becomes more susceptible to picking up a potentially lethal hospital-acquired infection. Transfused blood also may be damaged in storage, increasing the likelihood of heart attacks, stroke and kidney failure.

Considering the declining rate of blood donation, the wasted expense when units go past their shelf life and must be destroyed, and the availability of safer, more cost-effective alternatives, Gross said transfusions of donated blood should become the treatment of last resort.

“If we can limit the use of blood products, we’re benefiting our patients,” he said. “We’re trying to find alternatives and avoid situations where we have no option but to transfuse.”

Gross has developed a standardized approach for managing patients who are at risk of needing a blood transfusion. In addition to using blood-conserving measures during cardiac and other high-blood-loss surgeries, he said, doctors are now postponing some procedures while patients build up their blood with a synthetic hormone that stimulates the production of red blood cells. Patients also may receive infusions of iron, necessary to red blood cells’ ability to carry oxygen.

In the year since the blood conservation and management program at EMMC went into effect, the hospital has seen roughly a 30 percent reduction in the number of blood transfusions performed, Gross said.

He said there always will be a need for donated blood, to treat accident victims and others who have lost a lot of blood in an uncontrolled environment as well as those with certain blood disorders. But for many others, he added, the new blood management approach is a better solution.

“There is nothing in medicine that is risk-free,” Gross said. “Our goal is to choose the best option and do it the best that we can.”

For more information about blood management, visit the Web site of the Society for the Advancement of Blood Management at www.sabm.org. Meg Haskell may be reached at mhaskell@bangordailynews.net or 990-8291.