• Posted December 11, 2024

Removing, Storing Patient's Blood Before Liver Surgery Helps Avoid Transfusions

Canadian Rowan Ladd scratched her head when doctors said they might bank a blood donation from her at the start of her 2022 liver surgery, but she figured it couldn’t hurt.

“You’re told before surgery that the liver is so full of blood vessels that there are risks of major bleeding,” Ladd, a 46-year-old Ottawa mother of two, said in a news release. “I thought it was great that researchers were trying things to reduce those risks.”

It turns out this blood draw slashes in half the risk of a blood transfusion needed during liver surgery, according to results from the clinical trial in which Ladd was a participant.

“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,” co-lead researcher Dr. Guillaume Martel, chair of hepato-pancreato-biliary research at the University of Ottawa, said.

The practice, known as hypovolemic phlebotomy, could save one in 11 liver surgery patients from needing a transfusion, researchers report in The Lancet Gastroenterology & Hepatology.

“It works by lowering the blood pressure in the liver,” Martel explained. “It’s safe, simple, inexpensive, and should be considered for any liver surgery with a high risk of bleeding.”

About 10% of a patient’s blood is removed prior to major surgery, then given back to the patient if they need a transfusion while on the operating table. If they don’t need a transfusion, the blood is given back at the end of the operation.

Between a quarter to a third of liver surgery patients require a transfusion due to excessive bleeding, researchers noted.

Cancer is the most common reason for liver surgery and, unfortunately, having a transfusion is possibly associated with a higher risk of the cancer coming back.

For this clinical trial, researchers recruited 446 people slated for liver surgery at four Canadian hospitals between 2018 and 2023.

Once under anesthetic, researchers randomly assigned patients to either have a half-liter of blood drawn or just proceed with the surgery as usual.

Results show that less than 8% of patients who had their blood drawn prior to surgery required a transfusion, compared with 16% of those who didn’t undergo a blood draw.

The blood draw caused no more complications that usual surgery, and surgeons said the practice made the operation easier to perform because there was less blood obscuring the places they needed to cut.

Ladd wound up not needing a transfusion during her surgery, which was to remove cancer that had spread to her liver. Two years later, she remains cancer-free.

“I’m so glad I was picked, and I’m glad it will help other people,” Ladd said of the clinical trial.

“I looked at this surgery like it saved my life. I stopped working, I relaxed, I took care of myself,” Rowan says. “I was unlucky to get cancer, but it woke me up. Now I live life and I really enjoy it where before I was just existing.”

The blood draw can also provide significant cost savings, researchers added.

A blood transfusion in Canada costs more than $350 U.S. dollars, researchers said. By comparison, the blood bags and tubes used for hypovolemic phlebotomy cost around $20.

“Blood transfusions can save lives, but if you don’t need one to save your life then it’s better to avoid it,” senior researcher Dr. Dean Fergusson, deputy scientific director of clinical research at The Ottawa Hospital, said in a news release. “Blood is a precious and limited resource that we need to preserve as much as possible for those who need it most.”

The procedure is now being tested in liver transplantation, and should be considered for testing in other surgeries that typically involve substantial blood loss, researchers said.

“Now that we’ve proven removing blood before liver surgery reduces transfusions, we’re spreading the word and teaching our colleagues how to do it,” co-lead researcher Dr. François Martin Carrier, chair in transfusion medicine at the University of Montreal, said.

“Providers find it simple after they’ve done it once, and the impact on surgery is dramatic,” Carrier continued. “It’s now standard of care in the four hospitals that were part of the trial, and other hospitals around the world should start to adopt it after learning of our results.”

More information

Memorial Sloan Kettering Cancer Center has more about liver surgery.

SOURCE: University of Ottawa, news release, Dec. 9, 2024