Study touts transfusions with own blood
Austin researchers support practice for trauma patients
Patients who are bleeding profusely from a traumatic injury might face fewer risks by getting a transfusion of their own blood during surgery, and it costs less than transfusions using donor blood, a study by Austin researchers released Monday says.
Using a patient’s own blood is routine for many planned surgeries, such as open- heart, because patients can schedule their blood contributions and it eliminates the risk of a reaction to other donated blood and of receiving tainted blood. But self-transfusions are not as widely used for trauma patients, where contamination from “spilled blood” is a concern, according to the paper published in the Archives of Surgery by the American Medical Association.
The main author, Dr. Carlos Brown, medical director of trauma services at University Medical Center Brackenridge, said he didn’t know how many U.S. trauma hospitals routinely transfuse patients with their own blood. National organiza- tions that might know did not return calls. “It’s not a real common practice because of the time and resources involved,” he said.
One of Brown’s co-authors, Kalem Richards, vice president of Capital Area Perfusionists, the company that collects the blood in the operating room and processes it on the company’s equipment, said all of the Austin emergency departments use the technique. Richards said the blood is suctioned from the patient, mixed with an anti-clotting drug and spun in a centrifuge to separate out the red blood cells. The red
Hospitals with trauma centers have been doing self-transfusions in Austin since 1983.
cells are washed in saline, filtered and then transfused back into the patient.
Brown, Richards and others studied 47 patients at University Medical Center who received their own blood and 47 who got it from the blood bank between Jan. 1, 2006, and Dec. 31, 2007. The average cost per patient in the first group was $1,616 versus $2,584 per patient in the blood bank group, the paper said. However, for the self-transfusions to be cheaper, the patients had to receive at least two units of blood.
Richards said that his company’s costs for a self-transfusion is $375 regardless of the amount of the blood returned to the patient. But on blood transfusions from the blood bank, the cost is $216 per unit, he said.
The study “gives validity to the fact that it’s probably safe and it’s cost-effective,” said Dr. Michael Craun, trauma medical director of St. David’s Round Rock Medical Center.
Craun, who was not involved in the study, said he suspects that most major hospitals use the technique, although he has not seen many studies validating the technique. He said he’s probably used the technique 40 or 50 times in his 30-year career, including at Scott & White Hospital-Temple, where he worked before coming to Round Rock.
A major concern with it is contamination, which could cause sepsis, a blood infection, Craun said. Brown said it’s possible that some blood is infected, but “we don’t transfuse blood that is grossly contaminated,” he wrote in response to questions at the back of the published paper. His team will be reviewing data on sepsis, Brown wrote.
Hospitals with trauma centers — emergency departments equipped to treat the most severely injured patients, such as victims of gunshots and bad traffic accidents — have been doing self-transfusions in Austin since 1983, Richards said.
Not all trauma patients can be candidates for the procedure, said Dr. Pat Crocker, director of emergency medicine at Dell Children’s Medical Center. But Crocker, who has done the procedure for many years in Austin, said his experience with it was good.
“And it’s cheaper and it works,” he said.
Carlos Brown Austin doctor, others studied 47 patients who got own blood, 47 who got donations.