Blood Conservation Program
What is the Blood Conservation Program?
At Seattle Children’s Heart Center, our Blood Conservation Program provides safe, effective heart care for your child with less need for blood products or a blood transfusion. In many cases, we can do bloodless surgery — surgery without using any stored or donated blood products.
We routinely use methods to limit or avoid the need for blood products for all children who come to the Heart Center. We also work closely with families who prefer that their child not receive blood products or transfusions for religious, cultural and personal reasons.
What is blood conservation?
Blood conservation means using methods to limit blood loss during surgery. It is the standard of care for all patients at Seattle Children’s. Methods to limit blood loss can help reduce the need for stored or donated blood products.
What is bloodless surgery?
Typically, doctors have used stored or donated blood products to:
- Replace blood that a child loses during or after heart surgery
- Prepare (prime) a heart-lung pump to circulate a child’s blood during surgery
- Increase a child’s blood volume so the heart-lung pump can support the child more easily
For certain surgeries, the use of stored or donated blood products is the standard of care and is thought to be safest for the child. However, surgery can also be done without the use of stored or donated blood. This is called bloodless, no-blood or transfusion-free surgery.
Based on your child’s needs, bloodless surgery may be a safe option.
What’s special about the experience at Seattle Children’s?
Seattle Children’s Heart Center is dedicated to giving each child the best medical and surgical care with innovations like bloodless heart surgery. If you are choosing a hospital for your child’s heart surgery, we are happy to talk with you in advance about doing bloodless surgery here. Call the Heart Center at 206-987-2515.
Our focus is on safety
- Your child’s health is always our top priority. Our goal is to lower the risks of surgery for your child by limiting or avoiding blood products or transfusions when we can.
- Blood products and transfusions are used safely in millions of people each year, but they are not completely risk-free. Outcomes tend to be better in patients who do not receive blood.
- We are experienced with many different methods to conserve blood during your child’s care. Most are the standard for all our heart surgery patients, like doing fewer blood draws. Others will be part of your child’s treatment plan if needed, like giving them iron supplements to boost their hemoglobin.
- The Heart Center follows standard transfusion medicine guidelines about when children need blood products or transfusions. If your child does need these measures, we will give them. We do not withhold blood products or transfusions if doing so would put your child at risk.
- We follow evidence-based practices, like giving only as much blood as your child needs and giving a transfusion later in the surgery instead of earlier. Steps like these help improve outcomes for patients.
Care custom-made for your child
- We will plan and perform your child’s heart surgery to conserve blood and reduce the need for blood products and transfusions. Multiple studies of bloodless surgery show that it is at least as safe and effective as surgery using stored or donated blood.
- Your child’s team will work closely with you to decide on treatment that is right for your child, taking into account your beliefs and values.
- Before surgery, we will ask you to consent to procedures your child will need or might need. If you object to transfusions, we will talk with you about bloodless surgery options in order to understand, record and follow your wishes whenever possible.
Team-based approach for the best results
- Bloodless surgery requires the skills of many experienced specialists working as a team. Our surgeons have done complex heart surgeries using bloodless methods. They helped design many of the processes and techniques that other hospitals use around the country.
- Our expert cardiopulmonary perfusionists carefully check and manage blood flow and breathing for children on a heart-lung pump. Their training and experience are essential for bloodless surgery.
- Many more team members will be part of helping to conserve your child’s blood and avoid use of blood products. They include your child’s anesthesiologists, cardiac intensivists, cardiologists, nurse practitioners, nurses and others.
Advancing bloodless pediatric heart surgery
- The trend toward blood conservation and bloodless surgery started with adult patients. Seattle Children’s is a leader in bringing the same advances to pediatrics. This requires special knowledge and skills because children have less blood to begin with. The smaller they are, the less blood they have. People with less blood are more likely to need blood products.
- In recent years, we have expanded our blood conservation efforts. This has helped us avoid transfusions for many more patients, even the smallest children. From May 2020 to May 2021, we avoided transfusions for about 2 out of every 100 patients under 26.5 pounds (12 kilograms) who had open-heart surgery. A year later, after expanding our efforts, the number improved to 20 out of every 100 patients.
- We are among a small number of hospitals that can limit or avoid blood products and transfusions in newborns, whose volume of blood is much lower than in an adult.
- Typically, all newborns need a transfusion during their heart surgery or hospital stay, according to data from more than 80 hospitals across the country. In cases where we tried to do bloodless surgery for newborns, 25% of our patients avoided a transfusion during their surgery or stay at Seattle Children’s.
- For babies who need a heart-lung pump, Seattle Children’s uses a microcircuit. This special machine can support babies by circulating their small amount (volume) of blood, often without the need to add blood products from a donor.
Methods We Use
To lower the chance that your child will need blood products or a blood transfusion, we may use a wide range of methods, including these:
- Nutrition and medicines, such as iron supplements, to improve your child’s blood cell levels before and after surgery
- Fewer blood tests before and after surgery so we are only taking blood from your child’s body when tests are truly needed
- Smaller incisions and less cutting through tissue so your child loses less blood
- Changes to how we set up your child’s heart-lung pump so it uses less blood
- Cell Saver technology to collect, clean and return lost blood to your child during surgery
- Products (not made from blood) that we can put on an incision to help control bleeding
- Albumin to adjust your child’s blood volume
- Acute normovolemic hemodilution to limit loss of blood cells
- Special steps as your child recovers after surgery in the intensive care unit, like taking out their breathing tube as soon as it is safe so they can get nutrition by mouth instead of through an intravenous (IV) line
Who’s on the team?
Our experienced team provides the care your child needs in a sensitive and supportive environment. The team includes:
- Cardiac surgeons
- Cardiac anesthesiologists
- Cardiac intensivists
- Cardiopulmonary perfusionists
Contact the Heart Center at 206-987-2515 to find out about your child having bloodless heart surgery at Seattle Children’s.
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