Interviews

A Paradigm Shift in the Use of Blood Products

Dr. Hiep Dao |
MedStar Georgetown University Hospital

Summary

In recent years, there has been a paradigm shift regarding the use of blood products in surgery. Dr. Hiep Dao, assistant professor, Department of Anesthesiology, and co-director of Bloodless Medicine & Surgery Program at MedStar Georgetown University Hospital, describes how education in bloodless strategies and a multidisciplinary team approach has resulted in better outcomes.

Transcript

There’s literature about reducing the use of blood products in cancer patients, and the detrimental effects of using blood products in cancer patients, so that’s when I initially developed my interest in it…

The past ten years or so has been a paradigm shift in the use of blood…there was  push toward having everyone’s hemoglobin be at least 10, kind of that magic number, 10, and then the literature caught up, and practice caught up and people realized the risk of infection, the risk of side effects and perioperative …increased morbidity and mortality with the use of blood…caught my eye.

I felt like this was a new, evolving field, it really caught my attention

This is somewhat different, it’s a change in teaching. The thought was always, more is better, especially with blood….keep everyone tanked up, keep that tank full

The literature bears it out that it (bloodless) is beneficial…

It’s definitely evolving and it’s accepting. Over the last 10 years, 15  years, and we see it at Georgetown, here, just looking at our numbers – in 2006, 2007, we were transfusing over 15,000 units of packed red blood cells, and we’ve gotten down to 10-11,000, a drastic decrease…with getting as sick or sicker patients…get better results with decreased use of blood products. And it’s a nationally accepted trend…over the last decade and a half

It starts with education, educating our providers, educating people early on. Educating folks early on is a very easy thing to do, and it doesn’t take a lot of the technology that a lot of people think

The things we do in the operating room are very easy to do – cell salvage, meticulous hemostasis by the surgeon…many things that we …understanding that the less allogeneic blood we give usually the better the results

The understanding of – you don’t need a lot of big technological equipment; the understanding of giving less blood, the understanding of educating our patients as well, of the benefits of less use of blood, are all attainable in a setting, a rural setting where the equipment may not be available.

The surgeons are very much on board too, especially the spine surgeons, the orthopedic surgeons; they’ve seen the benefit of decreased use of blood, and it’s in their literature as well…we’ve gotten really no pushback.

We love it! Because the evidence bears it out, it bears out the benefit to our patients in a defined, tangible way. We’ve seen decrease in infection, we’ve seen decrease in costs of our healthcare, we’ve seen better outcomes, the tangible results, and we don’t always see that – the tangible results…across the country  there’s definitely a big drive for this care.

I think the approach that we’re taking – a very multi-disciplinary approach – is what really brings all this together – it’s not just from an anesthesia standpoint, or internal medicine or surgical, it’s really everyone coming together for the benefit of the patient. The whole idea of cura personalis and treating the whole patient, all of this is coming together…as a physician…all of us coming together on the same page..better medicine, and its proven

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