Administrative Office
St. Joseph's Hospital Site, L301-10
50 Charlton Avenue East
HAMILTON, Ontario, CANADA L8N 4A6
PHONE: (905) 521-6141
FAX: (905) 521-6142
http://www.fhs.mcmaster.ca/hrlmp/
Issue No. 69
QUARTERLY NEWSLETTER
June 2003
Perioperative Blood
Conservation Program
Many examples of Perioperative Blood Conservation programs exist in Canada. Each program
may differ in terms of composition, but all are similar in the ability to provide benefits to key
healthcare stakeholders. Perioperative Conservation programs can be seen as threads that tie
different stakeholder interests together, with the common goal of better patient care.
The move towards alternatives to allogeneic blood transfusion has in part been driven by
greater public awareness of inherent risks of donated blood and public fear, still prevalent
despite considerable measures to increase safety of the blood supply system. Hamilton Health
Sciences (HHS) is one of 23 sites participating in a Government of Ontario sponsored program,
ONTraC (Ontario Nurse Transfusion Co-ordinators), designed by Dr. John Freedman, Chief
Hematologist for St. Michael’s Hospital, Toronto. It is managed at each site by a Blood
Transfusion Co-ordinator who plays an integral role in the implementation of hospital blood
conservation strategies, evaluation of practices and problem solving. The program uses the
principles of evidence-based practice and patient centred care.
The program was established at HHS 18 months ago and is designed to restore confidence to
patients and physicians concerned with transfusion transmitted diseases (e.g. HIV, Hepatitis,
West Nile Virus, etc.), and has three goals:



Through education, reduce the number of allogeneic transfusions;
Make information available that will inform patients about non-blood products;
Improve general awareness regarding blood/blood products.
Benefits for both Patient and Health Care Professionals
The program offers numerous benefits to patients who require a blood transfusion and the
health care professionals who look after them.
The program expects to benefit patients through:






Receiving appropriate information regarding blood, blood products and alternatives.
Having sufficient lead-time to make informed and viable decisions (with health care
professionals).
Anemia is managed without unnecessary exposure to donated blood.
Recovery time from surgery, treatment, or illness is reduced, leading to better outcomes.
Better quality of life, including resumption of daily activities, increased “vigor” for
rehabilitation.
Lack of exposure to risks of allogeneic blood, including, iatrogenic diseases, hemolytic
reactions and decreased risk of immunosuppression.
By collecting evidence it is hoped that health care professionals will benefit through:






Performing continual prospective tracking of utilization of blood, blood products and
alternatives for the purpose of making knowledgeable recommendations for use.
Establishing policies and procedures aimed at minimizing exposure to allogeneic blood,
preventing postponements and cancellations of surgeries at times of blood shortages.
Assessing new therapies and alternatives as they become available and recommend
use.
Use of evidence-based principles and cost/benefit analysis where appropriate.
Education forum for healthcare professionals on blood, blood products and alternatives.
Establish informed consent as part of standard perioperative protocol.
The Hospital should see benefits that include less unnecessary use of blood resources with
blood saved for emergencies and other uses, fewer co-morbidities and complications resulting
in less of a need for follow-up and reduced average length of hospital stay.
What’s Happened at Hamilton Health Sciences?
Following a review by the transfusion co-ordinator, new flow sheets and patient education
materials have been developed for the use of blood and blood products that better represent the
term “informed consent”. Two pamphlets about autologous donation and decreasing a patient’s
need for a blood transfusion have been developed to help patients education and to provide
answers to some of their more common questions. In order to provide a better service to
patients a process is currently being designed that will take the program into the community.
Retrospective Audit
The biggest challenge/success was the results of the retrospective audit carried out in the fall of
2001. A prospective audit was undertaken in March, 2003, confirming the findings of the
original audit and was presented at the recent Canadian Society of Transfusion Medicine
Conference in Halifax. In the audit six surgeons who performed primary coronary artery bypass
surgery were followed. The results found are below.
Blood Utilization:
Number of patients
Retrospective Audit
Prospective Audit
October 2001
March 2003
70
60
72.5%
63%
7.7%
7.8%
Average Hb on admission
137.2 g/L
137 g/L
Average Hb on discharge
99.7 g/L
99.5 g/L
Average transfusion trigger
80 g/L
80 g/L
Utilization by individual surgeon
utilization
Autologous utilization
80 g/L
80 g/L
<8%
<8%
Percentage patients transfused
Autologous utilization
Conclusion
In this CABG cohort there appears to have been a transfusion trigger of 80 g/L. Very few RBC
transfusions occurred in the absence of a low Hgb (<80 g/L) or hypotension. Autologous use
was minimal (approx. <8%) and its use appeared not to be based on clinical grounds (low Hgb
and/or low blood pressure). Variance amongst surgeons was minimal.
Petra Cooke, RN BScN, Transfusion Coordinator, Hamilton General Hospital Site
Hamilton Regional Laboratory Medicine