A growing number of health-care providers here are using automated devices that recover and reinfuse blood lost by patients during surgeries.


Dr. Douglas McInnis, an orthopedic surgeon at Kootenai Medical Center, one of the latest hospitals to adopt the technology, says that he and the other orthopedic surgeons there are using the instrument, called an OrthoPat, to salvage blood lost by patients primarily during and after hip- and knee-replacement procedures. Since KMC began using the OrthoPat last winter, the percentage of those patients who have needed donated blood transfusions during and after surgery has dropped to about 5 percent from 20 percent, he says.


That reduction has benefited hospitals and patients alike, McInnis says.


Diminishing the amount of donated blood used in routine surgeries frees up the blood supply for emergency situations, he says. It also reduces risks for post-surgical infections related to donated blood.


That might explain the increasing popularity of the OrthoPat, which is being used in just under 5 percent of the 1.5 million knee- and hip-replacement surgeries worldwide that require transfusion, says Julie Fallon, a spokeswoman for Braintree, Mass.-based Haemonetics Corp., which manufactures the OrthoPat. Use of the OrthoPat jumped 67 percent in the U.S. last year, she says.


Haemonetics also makes another similar device called a Cell Saver, which is being used in about 90 percent of the 850,000 cardiovascular, trauma, and other high-volume blood loss procedures worldwide, Fallon says. Use of the Cell Saver has been declining slightly as surgeries are becoming more efficient and causing less patient blood loss, she says.


Tom Arnzen, a Spokane profusionist, a clinician who runs heart-lung machines in cardiac surgeries, says that most hospitals in the Inland Northwest now use the Cell Saver, which was introduced about 40 years ago. Arnzen also is a board member and consultant at Advanced Transfusion Services Inc. here, a company that distributes those machines and trains hospital personnel in how to use them.


Besides KMC, Northwest Specialty Hospital, in Post Falls; Samaritan Hospital, in Moses Lake; St. Joseph Regional Medical Center, in Lewiston; and Gritman Medical Center, in Moscow, use the OrthoPat, Arnzen says.


Each machine performs surgical blood salvage, or autotransfusion, by suctioning blood shed from patients incisions through a line that connects to a bowl inside of the device that acts as a reservoir, Arnzen says. Another line drips saline solution into the bowl to prevent clotting, he says.


The device spins the blood inside the reservoir to separate the different particles in the blood, and the centrifugal force pushes the red blood cells, the heaviest blood cells, to the outside of the bowl, Arnzen says. While the machine clears the bowl of plasma, saline, and other particles, it collects the red blood cells after an electronic eye senses that the container is full of those cells, he says.


After washing the red blood cells with a saline solution to clear away proteins or drugs, the machine transports those cells to a suspended bag that stores the blood in a clean solution and drips it into an intravenous line connected to the patient, he says.


The Cell Saver recovers blood lost during any of a number of different high-volume blood-loss procedures, including open-heart surgeries and vascular operations, Arnzen says. The OrthoPat specifically salvages blood lost by orthopedic-surgery patients, who tend to bleed more after their procedures are completed, he says.


Physicians began using basic autotransfusion devices during the Vietnam War, and Haemonetics introduced the OrthoPat about two years ago, Arnzen says. Most hospitals in the Inland Northwest use Cell Saver devices, and, besides KMC, two orthopedic clinics in Post Falls and two hospitals elsewhere in Eastern Washington use the OrthoPat, he says.


Both the Cell Saver and OrthoPat can save hospitals money by decreasing the risk that patients will develop post-operative infections, which often lead to longer hospital stays, Arnzen says. Performing autotransfusions also reduces the amount of donated blood hospitals must buy from blood banks, he says.


National trends show that 25 percent to 35 percent of orthopedic-surgery patients require up to two units, or 500 milliliters, of transfused blood, which costs a little more than $1,000 at a blood bank, or about the same amount of pre-donated blood, or blood drawn from a patient before surgery, Arnzen says. Reinfusing two units of blood with an OrthoPat costs about $600, he says.


Autotransfused blood is cheaper than donated blood because it doesnt have to be processed by blood banks, which have to meet numerous regulations that require much time and labor to satisfy, including screening the blood for antibodies, Arnzen says.


In autotransfusion, the same rules and regulations apply, but you dont have to go through all of the checks and balances to make sure its not mixed up with another persons blood, he says.


Salvaging patients blood also averts the risk associated with lab personnel making errors when processing donated blood, which causes more transfusion-related fatalities than infections or viruses such as HIV or hepatitis, Arnzen says. Though autotransfusion doesnt eliminate the need for donated blood, it helps ease the demand for it and relieves blood banks that are experiencing blood shortages, he says.


About 4 percent of able blood donors in the U.S. contribute their own blood to blood banks, Arnzen says. As the blood supply here and throughout the nation declines while the population increases, the use of new and better transfusion methods such as autotransfusion will help conserve donor blood, he says.


McInnis says that about one in five of his hip- and knee-replacement surgical patients require blood transfusions, and that some patients lose close to half a liter of blood after the operation has been completed.


Those patients usually lose high volumes of blood because the operations involve cutting bones, from which bleeding is hard to stop, he says.


Many of those patients are elderly and dont tolerate blood loss as well as younger patients, McInnis says.


Losing that much blood could be equivalent to making them climb a hill or shovel a driveway, he says. It puts a major strain on the heart.


Providing surgical patients with autotransfused blood rather than donated blood improves patient care by lessening risks for transmitted diseases and allergic reactions to donated blood, McInnis says.


Autotransfusion stops collecting blood when a wound stops bleeding, ensuring that virtually no blood is wasted, McInnis says. In transfusions of donated or pre-donated blood, patients typically use less than 60 percent of the blood, and the hospital pours the rest down the drain, he says.


Surgical blood salvage also provides a transfusion alternative to patients such as Jehovahs Witnesses whose beliefs prohibit them from accepting donated blood, McInnis says.


Some of them feel that receiving their own blood isnt in violation of that part of their faith, while others feel that it is, and dont want anyones blood, he says.


Autotransfusion offers a potentially life-saving option to those patients, some of whom choose to forgo surgery or to go ahead with it even though they could die from blood loss, McInnis says. Patients who receive any type of transfusion must sign a form that they consent to accept blood before they undergo surgery, he says.


McInnis says he hasnt seen any patients suffer complications from autotransfusions, but thinks a large-scale study should be conducted on orthopedic-surgery patients to rule out any possible risk of infection transmitted by autotransfusions.


Infusing any type of blood into a patient might cause risks for infection because the blood is exposed to the air, even if only for a short time, McInnis says. He says he must consider the potential liability for every decision he makes as a physician, and his concerns about autotransfusion are only theoretical at this point.


If I truly thought it is causing problems, I wouldnt be using it, he says.


Surgeons cant give autotransfusions to patients with cancerous tumors or infections because reinfusing their blood might spread the cancer or bacteria throughout their bodies, McInnis says.