Returning the Blood and Saving the Supply, the Veteran Affairs Medical Center (VAMC) Experience

Abstract

Abstract Introduction/Objective Blood conservation techniques such as perioperative autologous cell salvage (PACS) can reduce patient usage and exposure to allogeneic blood products during surgery. As all blood transfusions carry risk and cost, the avoidance of transfusion through PACS represents an opportunity to reduce risk of allogeneic transfusion related reactions or complications and reduce costs from blood product utilization. Although the benefits of PACS has been documented in the literature, quality assurance demonstrations of the blood volume returned to veteran patients undergoing surgeries with a high likelihood of significant blood loss are sparse; thus, we present the quality assurance study of PACS usage in a VAMC. Methods Quality assurance documentation from the American Red Cross (ARC) that provides autologous cell salvage services at the VAMC were examined from February 2017 to August 2018, for a total of 17 months examined. The procedure, estimated blood loss, and volume returned was documented as part of a quality assurance/improvement project. The volume returned was compared to the typical RBC volume (~250 mL) within a packed red blood cell volume (~350 mL). Results A total of 44 procedures took place corresponding usage of PACS. Of these 44 procedures, 15 had no estimated blood loss, and an additional 10 had too little estimated blood loss (<250 mL) for blood volume to be returned. Among the procedures with blood loss, an average of 864 mL of blood was lost (1230 mL when the low blood loss cases are excluded) with an average volume returned of 511 mL or the approximate equivalent of 2 units of RBCs when utilized. Two cases with significant estimated blood loss (5400 mL and 4850 mL) had 2250 mL and 2125 mL or about the equivalent of 9 RBC units each. The total volume returned to all patients was 9700 mL, or the equivalent RBC volume of 38-39 RBC units. Conclusion PACS is a procedure that can rapidly provide large quantities of autologous blood in surgeries with significant risk of bleeding. Blood salvage avoids or reduces the risks of allogeneic blood transfusion and reduces cost to the transfusion service as the autologous blood loss would not need to be replaced with allogeneic blood transfusions. PACS in the VAMC returned significant blood volumes to patients undergoing procedures with high risk of blood loss, therefore reducing allogeneic blood transfusion requirements in the veteran population.