A new study reveals that removing and storing a patient's blood prior to liver surgery can significantly decrease the need for blood transfusions. The clinical trial, conducted across four Canadian hospitals, found that hypovolemic phlebotomy, the practice of removing about 10% of a patient's blood volume before surgery, halved the risk of needing a transfusion during liver surgery.
The research, published in The Lancet Gastroenterology & Hepatology, involved 446 patients undergoing liver surgery between 2018 and 2023. Patients were randomly assigned to either undergo hypovolemic phlebotomy or proceed directly to surgery. The results indicated that only 8% of patients in the hypovolemic phlebotomy group required a transfusion, compared to 16% in the control group.
Mechanism and Benefits
According to Dr. Guillaume Martel, co-lead researcher and chair of hepato-pancreato-biliary research at the University of Ottawa, hypovolemic phlebotomy works by lowering blood pressure in the liver, thus reducing blood loss during surgery. The removed blood is re-administered to the patient if a transfusion is needed during the operation or at the end of the surgery if no transfusion is required.
"Taking out half a liter of blood right before major liver surgery is the best thing we’ve found so far for reducing blood loss and transfusions," Dr. Martel stated. He emphasized the safety, simplicity, and cost-effectiveness of the procedure, suggesting it should be considered for any liver surgery with a high risk of bleeding.
Clinical Implications and Cost Savings
Transfusions are commonly required in liver surgeries due to the organ's extensive network of blood vessels. Approximately 25% to 33% of liver surgery patients require transfusions because of excessive bleeding. Avoiding transfusions is particularly important in cancer surgeries, as transfusions have been associated with a higher risk of cancer recurrence.
The study also highlighted the potential cost savings associated with hypovolemic phlebotomy. The cost of the blood bags and tubes required for the procedure is approximately $20, while a single blood transfusion in Canada costs over $350. Dr. Dean Fergusson, deputy scientific director of clinical research at The Ottawa Hospital, noted that while blood transfusions are life-saving, avoiding unnecessary transfusions is crucial to conserve this precious and limited resource.
Future Directions
The researchers are now investigating the use of hypovolemic phlebotomy in liver transplantation and suggest its potential application in other surgeries associated with significant blood loss. Dr. François Martin Carrier, chair in transfusion medicine at the University of Montreal, stated that the procedure is becoming standard practice in the four hospitals involved in the trial and anticipates its adoption by other hospitals worldwide.
"Providers find it simple after they’ve done it once, and the impact on surgery is dramatic," Dr. Carrier said.
