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Patient Blood Management

There is no substitute for blood. It is the fluid that carries oxygen and nutrients to our vital organs. Transfusions can play a critical role in the care of patients being treated for malignancies, during and after surgery, and in the care of acutely injured patients. They can be a life-saving intervention.

However, as medical science has progressed in recent years, we have learned more about the benefits and risks of blood transfusions. A blood transfusion has been described as a liquid organ transplant. So, a decision to transfuse should always involve consideration of the expected benefit and the potential risks.

Transfusion with blood donated by others carries the risk of infection from viruses and other adverse reactions. The ability to distinguish those patients who absolutely must receive blood products from those who can be managed with limited or no blood products is an important advance in improving the quality of care and a key feature of blood management.

In 2007, we began the Maine's first comprehensive Patient Blood Management Program. This is part of our effort to provide patients with the safest, highest quality of care. The Northern Light Blood Management Program has been recognized by national organizations such as the Society for the Advancement of Blood Management.

Blood management is a systematic approach to patient care with the goal of preventing avoidable transfusions and ensuring the safe and efficient use of blood component therapy when it is necessary. This management approach emphasizes early diagnosis and treatment of anemia using pharmaceutical interventions rather than transfusion, and minimizing blood loss during one’s care in the hospital.

The use of blood in the United States is significantly higher than in most European countries (15 percent higher) and Canada (44 percent higher). Our blood management approach can reduce transfusion in a way that is safe, efficient, and more cost effective.

Patient blood management is a scientifically-based approach to reducing or eliminating the need for blood transfusion. In some healthcare organization, it may be referred to as bloodless medicine. Patient Blood Management is best care for all patients.

In addition, our Patient Blood Management Program offers comprehensive care for those people who refuse blood transfusions for religious or personal reasons or who accept blood transfusions or component therapy only in the most life-threatening circumstances.

For those patients who do not accept transfusions, “bloodless medicine” is available . However, our program aims to avoid transfusion in every patient when possible, and limit exposure to transfused blood when a “bloodless” approach is not desirable or possible.

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Everyone can benefit from Patient Blood Management.

Typically, blood transfusions have been given to patients who experience significant blood loss associated with acute illness or injury, and to patients who undergo certain types of major surgery. In addition to injury, other causes of blood loss include gastrointestinal bleeding, gynecological and obstetrical bleeding, vascular bleeding from a ruptured aneurysm. Bleeding may occur during surgery (perioperative bleeding). Acute hemorrhage can occur in trauma patients who may require surgical intervention to control bleeding in addition to receiving transfusions to replace red blood cells that have been lost. Patients undergoing cancer chemotherapy may also need blood transfusions.

Blood transfusions are often avoidable with Patient Blood Management (PBM). In addition, anemia should be treated whether there is risk for transfusion or not and anemia treatment is a corner stone of PBM. Minimizing blood loss inside the hospital should be part of everyone’s care.

The ability to transfuse blood is dependent upon a safe and ready supply of blood. Blood collection organizations are a vital link in this process. EMMC receives its supply of blood from American Red Cross through blood donated by healthy volunteers. If a transfusion is considered, the doctor should discuss the potential risks, benefits, and alternatives with you first, as part of an informed consent.  A common cause of transfusion today is blood loss from surgery. As many as 45 percent of patients have preoperative anemia. Pre-existing anemia increases a patient’s risk for needing a transfusion during or after surgery. An important part of blood management is identifying and treating pre-operative anemia. Iron-deficiency anemia is the most common type of anemia in the pre-operative setting, but there are other causes as well.

Learn more about iron-deficiency anemia

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If you remain anemic despite diet and other treatment measures, if you are acutely injured and experience significant blood loss, or if you have a chronic medical condition that cannot be effectively managed, your doctor may recommend blood transfusion(s).

  • Allogeneic blood, which comes from an anonymous donor, is available on an emergency basis. Blood components that may be given include: 

    • Red blood cells (RBCs)

    • Platelets

    • Plasma

    • Cryoprecipitate, which is a concentration of clotting factors taken from plasma

  • Autologous blood which is your own blood. There are two different ways in which your own blood may be used in a transfusion: 

    • Hemodilution is a technique whereby your blood is removed just before surgery and is replaced with intravenous fluids. Then, your own blood is returned to you after surgery.

    • Intraoperative autologous blood collection and reinfusion (Cell Saver or cell salvaging) occurs when blood you lose during surgery is collected, washed, filtered, and reinfused.

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Your blood is composed of many different elements or components, and each performs a specific function. For example, red blood cells (also called RBCs or erythrocytes) carry oxygen to the organs. A key part of the red blood cell is hemoglobin, the molecule that transports oxygen within the red cell. A low hemoglobin or red blood cell count signals anemia. The hematocrit is the percentage of the blood volume that is made up of red cells and is usually around 40-45 percent. The hemoglobin and hematocrit value are two essential numbers your doctor considers when evaluating you for anemia. These are numbers with which you should be familiar.

White blood cells (also called WBCs or leukocytes) fight infection. If there is a high white blood cell count, it may indicate infection. A low white blood cell count may signal a reduced ability to fight infection or disease and may be seen as a result of medications such as chemotherapy, or indicate a problem with your bone marrow.

Platelets are the blood element or component that helps initiate clotting. If the platelet count is low (also called thrombocytopenia), the blood may not clot normally, placing a person at increased risk for bleeding. A high platelet count is called thrombocytosis. Thrombocytosis may occur as a response to inflammation or iron deficiency, or as part of a bone marrow abnormality. Thrombocytosis may be associated with an increased risk for abnormal clotting or thrombosis.

Plasma, the liquid part of your blood, makes up about 60 percent of the blood volume. Plasma consists of water, proteins, and other chemicals such as hormones, antibodies, enzymes, glucose, fat particles, salts, and electrolytes.

You may have heard about clotting factors 8 and 9 with respect to hemophilia. In fact, there are many more clotting factors in plasma. Your doctor may measure levels of different clotting factors if you have abnormal bleeding or conditions such as von Willebrand’s disease. Other tests your doctor may order that evaluate your blood’s clotting capacity include the prothrombin time (PT) and partial thromboplastin time (PTT).

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Hemoglobin, the oxygen transport molecule in red blood cells, and hematocrit, the percentage of the blood volume that is made up of red blood cells, are two important numbers for you to know. These values will help you know whether you are anemic and at risk of needing a transfusion should you require surgery. Even if you do not need surgery, having anemia treated may improve your overall health and feeling of well-being.

If your hemoglobin and hematocrit values are too high or too low, your doctor may recommend treatment to normalize them. Sometimes the hemoglobin and hematocrit value may be normal, but you may still be low in iron or other nutrients or vitamins needed for blood production and your doctor may make recommended treatment.

Normal hemoglobin and hematocrit ranges

  Hemoglobin Hematocrit
Male 13 -17 g/dL 42 - 51%
Female 12 -15 g/dL 36 - 45%

Normal ranges for iron studies

Iron Study Normal range
Iron 45-182 mg/dL
Iron Binding 261-478 mg/dL
TransFerrin Saturation (TSAT) 20-45%
Ferritin 45-400 ng/mL

Normal range for vitamin B12 is 300-900 pg/mL

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Our Patient Blood Management Program uses a team approach to develop a plan of care that uses the latest drugs, technologies and techniques to decrease blood loss and enhance an individual’s own blood supply.

Before surgery, our physicians and surgeons follow a process to identify patients at risk for transfusion. Patients are screened for anemia (a condition where there are too few red blood cells). If anemic, patients may be treated with iron, erythropoietin (“EPO”) or both to increase their red blood cell count before surgery.

If patients are at high risk of transfusion for any reason, or simply decide they want to avoid blood transfusion, the program develops a coordinated approach to the patient’s hospital care that minimizes blood losses from blood draws and other procedures. In addition, during surgery, modern surgical technologies can collect, filter, and return patients’ own blood cells to their bodies to reduce the need for transfusions.

After surgery, our physicians work with our patients’ providers to help continue blood management techniques and treat anemia without blood transfusion throughout the hospital stay and after discharge whenever possible.

The same principles apply to non-surgical patients and the PBM team helps prevent, minimize and treat anemia to avoid transfusion and aid recovery in patients whether or not they’ve had surgery.

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In order to make decisions about managing your needs before surgery, it is important for you to take the time to consider information about transfusions and bloodless surgery options. Some of that information is available on this website. We have prepared this video to provide you with more in-depth information to help you make the best decisions with your doctor about your care needs.

If you have questions or need additional information, please contact Leon Binette, RN, coordinator of the Patient Blood Management Program at Northern Light Eastern Maine Medical Center, at 207-973-4928.

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Contact us today to get help with your Patient Blood Management needs.

Practice City Contact
Northern Light Patient Blood Management
489 State Street, Blaisdell Building, Level 4, Northern Light Eastern Maine Medical Center, Bangor, ME, 04401
Bangor 207-973-4928