Alternatives to Blood Transfusions

Doctors try not to order blood transfusions unless they are absolutely necessary because of the risk of serious complications, even though this risk is very small. Some approaches are available that can decrease the need for a blood transfusion. Others are still being investigated but if the research is successful, new alternatives to blood transfusions should be available in the future.

The following options are currently available:

• Volume expanders - Doctors use volume expanders to prevent or treat the shock associated with loss of body fluids. This approach is especially useful when a patient does not need any blood components but has lost a lot of body fluids. The most common volume expanders used include salt water (normal saline) and saline with some chemicals added (Ringer’s solution).
• Growth factors - Hematopoietic growth factors encourage the bone marrow to make more red blood cells. These growth factors can be made in the laboratory and given to people with low blood cell counts. Giving growth factors can increase red blood cell counts, white blood cells counts, or platelet counts. Growth factors can be given to patients before surgery to correct anemia (low red blood cell counts) or increase hemoglobin to higher than normal levels so that a loss of blood during surgery will not harm the patient.
• Hemostatic agents - Hemostatic agents increase the body’s blood-clotting ability. Agents such as aprotinin, desmopressin, and vitamin K are synthetic or natural products that increase the number of clotting factors. These agents decrease the risk of blood loss, which reduces the likelihood that the patient will need a blood transfusion.
• Blood salvage - One reason why patients might need a blood transfusion is to replace the blood lost during surgery. In some cases, surgeons can “salvage” blood during or after an operation by collecting it with a special machine. They then clean (filter) the blood and return it to the patient. This procedure reduces the need for blood transfusions from other people.
• Surgical techniques - Surgeons can sometimes use certain techniques that minimize the amount of blood lost during surgery. These techniques include:
  • Laser surgery - Use of an intense, narrow beam of light (laser beam) to cut through tissues.
  • Electrocautery - Use of heat produced by an electric current to destroy tissue.
  • Ultrasonic scalpel - Use of high-frequency sound waves to cut tissue.
  • Electrosurgery - Use of an electrical current to destroy cancer cells.
  • Laparoscopic surgery (also known as minimally invasive surgery) - Use of very thin instruments and a video camera; requires a much smaller incision (cut) than conventional surgery.
• Blood substitutes - Researchers are trying to develop a substitute for human blood that can be given to patients safely, without any risk of complications. Some of products being studied can carry oxygen to tissues like red blood cells, but they only last for 12 to 14 hours. At this point, blood substitutes are used only rarely. For example, they can be used as a temporary measure for patients with very rare blood types to tide them over until matching donated blood is located. They are also given to people whose religious beliefs do not permit blood transfusions.