08:49pm Tuesday 14 July 2020

Anemic patients face blood transfusion risks; doctors determining whether alternatives offer better outcomes

Dr. Gregory Hare

Dr. Gregory Hare

About one-quarter of the world’s population has anemia, or low hemoglobin, stemming from a number of sources, including nutritional and iron deficiencies, sickle-cell anemia, trauma and blood loss during surgery, said Dr. Hare, who is also a staff anaesthesiologist at St. Michael’s.

Hemoglobin, or red blood cells, are key to transporting oxygen to the brain, heart and other vital parts of the body, a role that is jeopardized in cases of anemia. Low hemoglobin is a risk factor for stroke, kidney injury and even death.

While a life saver in boosting hemoglobin levels among patients with acute blood loss, red blood cell transfusions themselves can be risky, increasing infections and longer stays in hospital, said Dr. Hare. He noted that anesthesiologists transfuse about half of the one million units of blood given to patients in Canada every year.

One of the main goals of the Centre of Excellence is to more clearly identify which non-emergency patients will fare better with a blood transfusion, and which will benefit by using alternative methods, like taking iron supplements prior to surgery.

“What we’re trying to find is the balance between the risk of anemia and low oxygen delivery and the risk of the transfusion,” said Dr. Hare. “We need to better understand when a transfusion is a good idea and when we can avoid it. We’re still wrestling with this.”

That balance not only varies from patient to patient, but also for each group of patients. For example, anemic patients having heart surgery may have a different threshold than patients having hip and knee surgery. Dr. David Mazer, an anesthesiologist at St. Michael’s, is leading an international trial to determine what ranks as the safest hemoglobin level for blood transfusions in patients undergoing heart surgery.

The issue of hemoglobin thresholds and patient risk is the major topic of discussion on Oct. 26 when the hospital plays host to an international symposium on blood patient management at its Li Ka Shing Knowledge Institute. Thesymposium is supported by an educational grant from Ethicon Biosurgery, part of Johnson & Johnson Medical Companies, and Janssen Inc.

Dr. Hare and fellow co-director Dr. Katerina Pavenski, who is also director of transfusion medicine at St. Michael’s, along with Dr. John Freedman, head of the Ontario Nurse Transfusion Coordinators (ONTRaC) Provincial Conservation Program, are developing a Centre of Excellence for Patient Blood Management with the goal of becoming a global leader in patient care and in training, research and education for health-care professionals. Dr. Hare said doctors are trying to treat anemia before non-emergency surgeries, such as knee and hip replacements, but it’s difficult to change the current system.

“In current health economic terms you have to show the cost benefit and the onus is on us now to do that,” said Dr. Hare, adding that the average cost of transfusing one unit of blood is $800-$1,200. “The bigger issue of course is the patient. We are now building a trials program to effectively treat anemia and determine whether patients have shorter hospital stays, fewer infections, less mortality and less organ injury. To my knowledge, this hasn’t been done yet.”

For more information and the list of speakers, please see: www.stmichaelshospital.com/programs/labs/symposium.php

About St. Michael’s Hospital

St Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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