Operating with autologous blood – the blood washing machine makes it possible
Blood supplies are scarce and expensive. The Dresden Heart Center was the first clinic in Saxony to join a network that works to save blood. The patient also benefits.
By Kornelia Noack
4 Min.
Professor Jens Faßl during an operation at the Dresden Heart Center. He looks after the cell saver, which can be used to reprocess the patient’s blood during the operation.
© Thomas Kretschel
Whether the use of an artificial hip joint, a bypass operation or the removal of a tumor: Patients lose blood with every surgical procedure. It is usually replaced by a blood supply. But blood is scarce. The number of donors in Germany has been falling continuously for years.
According to the Paul Ehrlich Institute, 6.5 million blood donations were collected in 2021, compared to 7.6 million ten years earlier. The main reason for this decline is the aging population. The uncertainty about the corona virus has exacerbated the situation.
Patient gets his own blood back
The Heart Center Dresden therefore relies on a cell saver – colloquially a blood washing machine. “This allows us to collect blood lost during the operation, process it and give it back to the patient in a timely manner. So he gets his own blood back,” says Professor Jens Faßl. He is chief physician at the Institute for Cardioanaesthesiology at the Heart Center.
The use of Cell Savers and the associated economical use of blood is part of what is known as Patient Blood Management (PBM). The Dresden Heart Center is the only facility in Saxony that belongs to the Germany-wide PBM network. “The aim is to increase patient safety,” says Ursula Marschall from the Barmer Institute for Health Systems Research.
The Cell Saver – a kind of blood washing machine.
© Thomas Kretschel
The PBM concept starts even before a planned operation. “Trained doctors in the hospital take a close look at the patient and his/her medical records long enough before a planned intervention. Typical questions are then: What do his blood values look like? Is there anemia?” Marshal says.
An examination for anemia is a prerequisite for an intervention. Anemia is a common reason for blood transfusion during surgery. It is also advisable to ask your family doctor before an operation: What is my blood like?
Save blood through special surgical techniques
The second step is to keep blood loss as low as possible during the operation. This includes, for example, taking as little blood as possible from the patient during the preliminary examination using smaller tubes.
Doctors can also save blood by operating with special techniques and reprocessing the blood with the help of cell savers during the operation. Last but not least, the standard includes weighing up the risks of an allogeneic blood transfusion and only using it when it is really necessary.
Germany is world champion in blood transfusions
Nowhere in the world is the number of blood transfusions as high as in Germany. According to the Barmer hospital report, more than 3.2 million blood units are administered in hospitals in Germany. And Saxony – after Mecklenburg-Western Pomerania – takes second place in the state statistics. The rate of transfusions is now falling by almost three percent every year.
The Barmer and the Dresden Heart Center work together on the subject of patient blood management: Dr. Fabian Magerl, Managing Director of Barmer Sachsen, Prof. Dr. Jens Faßl, Deputy Medical Director of the Heart Center, and Jörg Scharfenberg, Business
© Heart Center Dresden/Robert Reuther
But for Barmer country manager Fabian Magerl it is clear: “With PBM you could save a third of the blood supplies.” That would be almost one million preserves nationwide. The health insurance company, which insures almost 318,000 people in Saxony, has therefore concluded a supply contract with the Heart Center Dresden.
Last year, the Heart Center was able to recover around 570 liters of blood just by using Cell Savers, which corresponds to almost 1,700 blood units that were available for other emergencies. Jens Fassl says that 70 percent of the procedures were done without any blood. blood is precious. A can contains about 200 to 300 milliliters of red blood cell concentrate and costs 80 euros on average.
Blood products increase mortality risk
Patients particularly benefit from the PBM concept. “Studies have shown that every blood transfusion poses a high health risk and increases the mortality rate,” explains the doctor. “The immune system is already weakened during an operation. If blood is then administered from another source, the risk of infection and wound healing disorders increases.”
This was also revealed by the Barmer hospital report. Blood transfusions can have a negative impact on the quality of treatment, especially in people with anemia. About every fourth German suffers from the disease, which is characterized by a lack of red blood pigment. Typical symptoms are headaches, tiredness, shortness of breath and poor performance. However, the disease often goes undetected. The most common cause is iron deficiency.
If a Barmer patient is diagnosed with anemia before the operation at the heart center, the new agreement means that the insurance company will cover the costs for the often expensive treatment with iron injections or other preparations.
Only 40 clinics in the PBM network
Should all patients be routinely tested for anemia before surgery in the future? “No,” says Professor Fassl. “In the case of younger patients and interventions with a very low risk of bleeding, sometimes no blood is kept ready at all, so diagnosing anemia makes no sense.”
Other clinics in Saxony also work with the blood management concept, but are not certified accordingly. To date, around 40 of the almost 2,000 clinics nationwide have joined the PBM network. “We hope for an initial spark,” says Chief Physician Faßl.
