Blood Management and Bloodless Medicine
The Blood Management and Bloodless Medicine service at Mount Sinai Beth Israel coordinates bloodless health care throughout the institution, encouraging use of the pharmaceuticals, surgical procedures, and technologies that will avoid transfused blood and its 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 may accept blood derivatives), we believe in careful compliance with each patient's wishes.
How Our Blood Management Program Works
If you request blood management, our program staff will offer you personalized attention, providing you with information on blood products and transfusion alternatives, as well as methods of identification (including an arm band) to alert all clinicians to your preferences.
Even if you do not request blood management, efforts are made hospital-wide to avoid unnecessary transfusions. For instance, Mount Sinai Beth Israel offers low-volume blood draws, transfusion alternatives for anemia, and minimally invasive procedures, which involve minimal blood loss.
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 a synthetic hormone to stimulate red blood cell production, drugs to stimulate white blood cell production, hemostatic agents to reduce blood loss during surgery, and intravenous iron infusions for anemia.
- Lab technologies. Practices include the use of low-volume tubes, which draw minimal amounts of blood.
- Anesthesia: Techniques include hypotensive anesthesia (which induces low blood pressure to decrease operative blood loss), normovolemic hemodilution (in which blood is slowly drained inside a closed system before surgery and simultaneously replaced with fluid), and volume expanders (which help maintain fluid volume so patients can tolerate some loss of blood).
- Surgical techniques and equipment: These techniques include blood salvage technology (such as the Cell Saver, which recycles blood lost during surgery), embolization (which strategically blocks blood vessels), retrograde autologous priming of the heart-lung machine (which allows a patient's blood to replace some of the priming fluid in the heart-lung machine that circulates blood during surgery), electrocautery (which uses heat to stop vessels from bleeding), harmonic scalpel (which uses vibration to cut and simultaneously cause blood clotting), and the argon beam coagulator (which clots blood during surgery).
- Biological products: These include collagen and cellulose pads that stop bleeding by direct application, and fibrin sealants that cover large areas of bleeding tissue.