Reduce blood transfusions to improve patient survival… Expansion of ‘bloodless surgery’ for heart and artificial joints

Breaking the stereotype that ‘surgery = blood transfusion’ in Korea, more and more places are implementing ‘transfusion-free (minimal transfusion) surgery’ that minimizes or does not require blood transfusion. As a consensus has been formed that blood transfusion threatens patient safety, medical staff and the government are making efforts to minimize the amount of blood transfusion. Advances in medical technology, such as drugs and advanced equipment, are the driving force behind transfusion-free surgery. Park Jong-hoon, a professor of orthopedic surgery at Korea University Anam Hospital, said, “With medical advances, it is now possible to safely treat patients with minimal blood transfusion.”

Blood transfusion is the easiest and most efficient way to supply insufficient blood. Nevertheless, the reason why the medical community pays attention to bloodless surgery is that there are ‘two sides of the same coin’ in blood transfusion.

First, it is immune rejection. As the body’s immune cells regard other people’s blood as an ‘enemy’ and attack it, such as bacteria and viruses, minor side effects such as fever and hives or fatal side effects such as acute lung damage may occur.

Second, the risk of infection. Although sterilization and inspection technologies have advanced, it is difficult to completely protect patients from germs caused by blood transfusion, hepatitis B and C, or new viruses.

Although rare, accidents still occur in the process of transfusions of different blood types. According to data released last year by the Institute for Medical Institutions Evaluation and Accreditation, an accident occurred in which a medical institution transfused type B blood to a type O liver cancer patient. The medical staff confused the two bloods stored in the same compartment of the dedicated refrigerator. The blood transfusion was immediately stopped, but it could have been in a serious situation due to an immune rejection reaction.

A paper published in the international journal The Lancet in 2011 analyzed the big data of 220,000 surgical patients and found that patients who received blood transfusions had a 100% increase in mortality and an 80% increase in the risk of complications. %, 30%).

Recently, insufficient blood volume has also emerged as a problem. There is a sense of crisis that if blood transfusions are excessively used unnecessarily, enough blood may not reach the patients who really need it. Noh Jae-hwi, a professor of orthopedic surgery at Soonchunhyang University Seoul Hospital, said, “In addition to low birth rates and aging, blood donations have decreased in general since the COVID-19 pandemic, resulting in an increasing number of cases in which surgery is delayed or canceled because blood cannot be obtained.”

According to the blood transfusion guidelines, healthy adults usually do not need blood transfusions except when the hemoglobin (hemoglobin) level in red blood cells is less than 7g/dL or when more than 30% of the total blood lost from the body (about 1.5 liters) is lost. This is because the body changes for survival, such as the body fluid passing into the blood vessels to maintain volume or the oxygen carrying capacity of red blood cells to be strengthened even if some of the blood is lost.

There are many ways to reduce blood transfusions. You can prepare for bleeding by increasing the quantity and quality of blood by using iron supplements or hematopoiesis before and after surgery. ‘Cell Saver’, which collects and re-injects blood that is unavoidable during surgery, is also expanding its application areas to heart, artificial joint, and fracture surgery. Minimally invasive (incisional) surgery using advanced equipment such as endoscopy, laparoscopy, and robots leads to minimal incision → reduction in blood loss → minimization of blood transfusion. It also has the advantage that the patient’s recovery is fast because the surrounding tissue can be preserved. Of course, depending on the patient’s age, underlying disease, hemoglobin level, hematocrit, cardiac output, etc., blood transfusion may be required even for the same operation. The same goes for excessive bleeding in an accident or major surgical operations such as cancer, heart, brain, or severe lung disease.

What is important is the interest of the medical staff and patients. Bloodless surgery is widely used in Australia and the United States. One reason is the high price of blood in these countries. Compared to them, the blood transfusion rate in Korea is still high. As a result of the blood transfusion adequacy evaluation conducted by the Health Insurance Review and Assessment Service last year, the blood transfusion rate for knee artificial joint surgery was 41% in Korea, far higher than the United States (8%), the United Kingdom (7.5%), and Australia (14%).

[박정렬 매경헬스 기자]