During my time as a Blood Collection volunteer, I have been constantly asking myself “what more can we do to get more people to donate blood?” until finally, I realized that this was the wrong question. There is a LOT to think about when it comes to blood banks. How is what we have already accumulated being used? What are we doing to make these numbers better than yesterday? In short, what more is the medical world doing to utilize blood already donated? Became a question just as valid, if not more. Anyway, what I found truly stitched a bond between healthcare and I, and in returning back to the question I may have a little more influence over, “what more can we do to get more people to donate blood?” I offer my insights in hopes that an extra-special bond with our medicinal heroes will help you to visualize their needs (and the patients’ need) for our blood donations.
Frank, Steven M., and Courtney G. Masear. “Optimizing preoperative blood product orders at the Johns Hopkins Hospital.” Medical Laboratory Observer Oct. 2013: 13+. Academic OneFile. Web. 11 Mar. 2014.
- MWA Chu, KL Losenno, K Moore, D Berta, J Hewitt, F Ralley. “Blood Conservation Strategies Reduce the Need for Transfusion in Ascending and Aortic Arch Surgery.” Perfusion Vol. 28 (2013): 315-321. Medline. Web. 11 Mar. 2014
On The Outside, Looking In
Most of us met with the introduction of blood donation as early as childhood from the commercials on public television, or at least by high school when the sign-up sheet passes by in study hall. And by now, as grown adults, somewhere in our consciences, we know that blood collection is important. A group of us has donated, and are now even more aware of the deep gap between supply and demand. To even a slight extent, enough of us know there is a need for more blood. Yet, not enough of us donate. Many people do not know what is being done for blood supply on “the inside”–in medical research institutes and hospitals, and the commitments being made nationwide to stretch every generous donation to help as many patients as possible. The emotional bond between these two parts of the same team has not been established. Today, we will attempt to create one.
Every day, many of us street walkers find our way into a blood drive and manage to muster up enough courage to surrender our median cubital veins to one of the largest-size needles available (I call it “the hose”), and allow a certified medical employee to drain 16 ounces of blood from our bodies to give to a complete stranger—after they check it for mad cow, of course. After the blood is taken, and finishes going through all kinds of processing, it eventually makes its way to a blood bank in a hospital or a major medical institute. When it gets there, responsibility to do amazing things with it falls in the hands of amazing people we never see or think of. With this blood has come a lot of progress, and a lot of potential. Hospitals around the country are constantly revising protocols for ordering blood products based on experience with your last donation, and studies are being done in pursuit of the next big breakthrough on surgical blood loss to conserve and better utilize your future donations. Somebody somewhere has been innovating equipment, re-writing the books on surgery, and exploring different techniques to keep the people on their tables free of harmful and stressful blood transfusions so that the blood they already have in stock can go to somebody who did not have such a fortunate alternative. Incredible things are being done with our blood.
At Johns Hopkins Hospital in Baltimore, Maryland, surgeons and anesthesiologists are modifying protocol referred to as the MSBOS (Maximum Surgical Blood Order Schedule). As authors Steven M. Frank and Courtney M. Masear tell us in their article “Optimizing preoperative blood product orders at the Johns Hopkins Hospital” which appeared in Medical Laboratory Observer in October 2012, MSBOS has been around since 1971. While this protocol has earned its commonplace status in operating rooms across the country, new techniques and procedures have been making their way to the competition. Maximum Surgical Blood Order Schedules are typically developed around a hospital’s surgical staff and their blood bank, and a ‘good’ MSBOS alters based on types of procedures, institutional location of operation, and blood usage data. Anesthesia Information Management System, or ‘AIMS’, is the new digital tracking system used by more and more anesthesiologists every day(Frank, Masear).
“Every day, thousands of surgical procedures are performed in the United
States. For each procedure, Anesthesiologists and surgeons are faced with
the question of whether or not to order blood products for potential intra-
operative use…Ordering blood products can be controversial. If products
are ordered liberally, resources are stretched…if products are not ordered
when needed, an unexpected hemorrhage in the operating room could be
One common utilization of blood is the result of ‘perioperative’ bleeding. According to Achal Dhir’s clinical report “Antifibrinolytics in Cardiac Surgery” published in Annals of Cardiac Anesthesia between April and June 2013, cardiac surgery is a magnet for blood transfusion. Dhir notes that “50-60% of cardiac surgery patients receive blood transfusions. Unfortunately, the higher in frequency of blood transfusions a patient climbs, their risk of morbidity (disease/illness) and mortality climbs up alongside. As Dhir states, “the best logical option is to reduce blood loss during cardiac surgery.”(Dhir, 117.)
Achal Dhir’s clinical report is dedicated to the discussion of agents currently being used/tested for reduction of surgically-induced bleeding which promote coagulation in the blood. This sounds simple until you observe the products in the running for this groundbreaking role in surgery, and what kind of numbers they are putting out. “Antifibrinolytic agents”, or basically a chemical that promotes clotting of blood in the body, are currently the mainstay in terms of procedural recommendation. However, each substance currently being highlighted for study does not come without troubling companionship of nasty side affects and death. Aprotinin once stood as king of surgical coagulation agents, but has since been disfavored by doctors, governments, and medical societies worldwide (except for Canada, who also isn’t a very big fan.). In this article concerning the entire compartment of Antifibrinolytics available, all kinds of components, from Tranexamic Acid, Epsilon Aminocaproic acid, Lysine are observed for their relationship with patients undergoing ‘Cardiopulmonary Bipass’ (a practice involving a machine which diverts blood away from the heart to be pumped to the body and to keep red blood cells supplied with oxygen). In short, it appears that the higher the function of the agent, the higher the risks were for mortality. However, for some agents (more than others), a happy medium could be attained depending on the patient in question. (Dhir, 117.)
“…After extensive tissue injury and CPB…increased fibrinolysis contributes to bleeding and coagulopathy. A comprehensive approach to blood conservation during cardiac surgery is highly recommended, including antifibrinolytic therapy. There is enough evidence to support the use of antifibrinolytic agents in cardiac surgery…All three agents are effective, but are not without side effects. The degree of side effects seems to parallel the efficacy of these agents…The onus is on the researchers to prove aprotinin’s benefits in high-risk patients…Till then, we will have to rely on lysine analogs…”(Dhir, 117)
The last piece of the medical puzzle I have left to give you is not one of any lesser importance. Beyond medical trials and data sheets, there is one last defense against catastrophic blood loss: the surgeon. In 2013, a study was published by Assistant Proffessor of Surgery Michael W. Chu and co-authors KL Losenno, K Moore, D Berta, J Hewitt and F Ralley titled “Blood Conservation Strategies Reduce the Need for Transfusions in Ascending and Aortic Arch Surgery” which measured the use of different conservation strategies performed by a single surgeon in a study. Compared to a ‘control’ group of patients receiving standard care (labeled the ‘CONV’ group in the study) of being subjected to transfusion if necessary, the surgeon operating on test group patients (referred to as ‘MWC’ [I believe that would be Dr. Chu]) delivered on a list of new procedures promoting the evasion of blood transfusion, such as ‘intraoperative acute normovolemic hemodilution‘: a blood conservation technique which involves removing blood from a patient’s system, ‘anticoagulating’ it (un-clotting), and maintaining at room temperature until it is ready to be re-routed into the body again.(Medicinenet.com) Procedures like these ask of surgeons to re-arrange their sense of direction and instinct in front of an operating table, flopping mid-study or renovating the way future doctors will think about protocol. This time around, the conclusive results had a very satisfying last-laugh at times past:
“…Multimodal blood conservation strategies reduce the need for allogeneic blood transfusions in proximal aortic surgery. Patients…with these blood conservation strategies also tend to experience reduced morbidity in any of 10 major postoperative complications…previous investigations have largely excluded this higher risk population from blood conservation measures. While there is currently no consensus on the most appropriate methods for blood conservation in aortic surgery…a comprehensive approach is efficacious in reducing the need for allogeneic blood products…reducing the risk of transfusion-related complications without any increase in mortality…”(MWA Chu, 321)
By stepping up to the plate and re-arranging their own movements in the O.R., surgeons press towards keeping the blood banks stocked. Working technology and innovation in their favor, anesthesiologists make sure each patient receives the respective quantity of blood. And by changing rules in the system for everyone, doctors everywhere are moving our nation’s blood banks to a place of stability and reliability. Each and every time we offer our veins, we give those medical specialists another chance to “do it better [this] round”. Without our contributions, these scholarly physicians would be ‘dead in the water’, so to speak. We are apart of this. And in the end, we’re all working to save somebody special—on both sides of this team.