Study touts trans­fu­sions with own blood

Austin re­searchers sup­port prac­tice for trauma pa­tients

Austin American-Statesman - - METRO & STATE - By mary ann roser

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.

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