About Bloodless Medicine

Mount Sinai’s Bloodless Medicine and Surgery Program coordinates bloodless health care throughout the health system, facilitating the use of pharmaceuticals, surgical procedures, and technologies that avoid transfused blood and its major components.

There are many excellent reasons to reduce transfusions and blood-based products. A policy of avoiding unnecessary transfusions gives all patients improved chances of reduced infection and often leads to quicker recovery. Careful blood management also conserves blood during shortages. In addition, some patients avoid donor blood or blood products for personal or faith-based reasons. Because not all refusals of “blood” are the same (some patients refuse whole blood and its major components, while others accept blood derivatives), we believe in careful compliance with each patient's wishes.

Blood Management Techniques

There is a growing range of techniques that allow physicians to avoid the need for donated blood and blood products.

We use blood management alternatives in the following areas:

• Pharmaceuticals: Pharmaceuticals include medications to stimulate red blood cell production, drugs to stimulate white blood cell production, drugs to stimulate platelet production, hemostatic agents to reduce blood loss during surgery, and intravenous iron infusions for iron deficiency anemia.
• Lab technologies: These practices include reduced phlebotomy frequency and the use of low-volume tubes, which draw minimal amounts of blood.
• Anesthesia: Examples of these techniques include hypotensive anesthesia, which induces low blood pressure to decrease operative blood loss, as well as normovolemic hemodilution, in which blood is slowly drained inside a closed system before surgery and simultaneously replaced with fluid. Another technique uses volume expanders, which help maintain fluid volume so patients can tolerate some loss of blood.
• Biological products: These include collagen and cellulose pads that stop bleeding by direct application, and fibrin sealants that cover large areas of bleeding tissue.

Our surgical techniques and equipment also offer blood management alternatives, including the following:

• Blood salvage technology: This includes the Cell Saver, which recycles blood lost during surgery.
• Embolization: This technique strategically blocks blood vessels.
• Retrograde autologous priming of the heart-lung machine: This allows a patient's blood to replace some of the priming fluid in the heart-lung machine that circulates blood during surgery.
• Electrocautery: This technique uses heat to stop vessels from bleeding.
• Harmonic scalpel: This device uses vibration to cut as well as promote blood clotting.
• Argon beam coagulator: This technique acts to clot blood during surgery.