Successful operation

“It’s better for the patients if blood transfusions are avoided during surgery.” This is something Donat Spahn, Director of the Institute of Anesthesiology (UHZ), is convinced of. Even if the same blood group is used, the body can still produce a defense reaction. The implications of this range from fever to organ damage. This is hardly surprising, as a blood transfusion is almost comparable to an organ transplant, which the body has to become accustomed to.

In June 2018, Donat Spahn led the first Swiss specialist seminar on “patient blood management” (PBM), in order to increase awareness of the new approaches to avoiding transfusions. Junior doctors and senior decision-makers from different countries were invited to the seminar to share this knowledge all over the world and build an international network. The seminar was made possible thanks to a donation by the CSL Behring Group to the University Hospital Zurich Foundation.

The UHZ plays a pioneering role in PBM. “Over the last five years, we have reduced the use of donated blood by at least 30% thanks to PBM,” says Spahn. He now hopes for more financial support for further training events. Today, blood transfusions are frequently carried out, and knowledge of PBM is not particularly widespread.

One of the main reasons for blood deficiency after an operation is often, in addition to blood loss, iron deficiency (anemia) in the patients. “One in three patients are anemic before the procedure,” explains the experienced anesthesiologist. “If iron is lacking, the body cannot produce enough blood during and after the operation.” Women are often affected by iron deficiency, and it can also be caused by tumors or kidney problems.

Part of patient blood management includes treating the iron deficiency before a planned operation. During the procedure, it is then necessary to minimize blood loss, monitor it continuously and, if required, administer drugs to improve coagulation. Specific surgical techniques can also help to minimize blood loss.

For unplanned operations, for example after an accident, monitoring blood coagulation and the fast and targeted correction of disturbances is of crucial important, states the experienced physician. Even in these cases, blood transfusions should be given very conservatively. After the procedure, intravenous iron supplements and other medications can be administered to increase blood production. This has proven to be successful in young mothers, who have recovered more quickly after experiencing blood loss during child birth.