Towards bloodless surgery…
There is no such thing as “bloodless” surgery – let’s make that clear. There is, however, blood loss that is insignificant, like when you cut yourself shaving, and then there’s significant blood loss such happens after major trauma cases with multiple fractures. As surgeons, often responsible for that blood loss, we try as much as we can to minimise blood loss, and hence the need for transfusion. And before you ask, if you’ve lost red cells, then there is nothing available yet that can replace the oxygen carrying capabilities of those red cells like, you guessed it, red cells.
Placing a patient on a well padded and designed operating table is often the first step in minimising blood loss. The “Jackson table” is, in my opinion, currently the best table for large posterior spinal cases. It allows the abdomen to hang free and the pads are soft and well positioned. Other positions, such as on the side, can also be used for different approaches which minimise blood loss simply due to their anatomy. An ALIF, for example, can be an operation that involves very small amounts of blood loss just by it’s approach.
Many of us practice “minimally invasive surgery”. This is poorly defined as everyone has a different opinion of what it means, but in principle it is about doing an operation through a smaller incision than how it was done before. Whilst it may appear like these techniques lose less blood, often the blood loss is kept hidden. Muscles are still being retracted and dissected, and bones are being cut, both of which lead to blood loss, but because the skin incisions are so small, often that blood is kept inside the skin. In the long term the body with resorb that blood, but in the short term effectively that blood is out of your circulation and so it still lost to you.
It’s important to tell your surgeon what medications and supplements you’re taking. Many of these can increase blood loss, and cause postoperative epidural haematomas that may press on the spinal cord. We also often use a medication called tranexamic acid, which has been proven to reduce blood loss during your operation.
Like many other surgeons I use a machine during my large operations called a “cell saver”. This takes the blood that you have lost, washes it, and allows us to give you back your red cells. It doesn’t give you back all your blood, like platelets and clotting factors, but it does give you back your oxygen carrying red cells.
When it’s needed
Of course, despite our best efforts, a blood transfusion is sometimes necessary after elective procedures. In trauma cases where we’re often dealing with multiple fractures and abdominal bleeding, transfusions save lives. Fortunately in Australia we have a very safe and efficient blood donor system run through the Red Cross. Yesterday I gave my 98th donation, and if you’re able to, I recommend you consider donating as well. Every time you give blood, you can just about guarantee that your blood is going to someone who may die without it. I’ve even learnt something about my own blood. My platelets are a very rare type (HLA 1bb 2bb), with less that one percent of the population having the same, and they can be used to treat Neonatal Alloimmune Thrombocytopenia, a rare but often catastrophic bleeding disorder of newborns.
So why don’t you consider giving blood? You’ll be saving someone’s life, and one day you might need the gift that a donor made for you.