Contributor: Edward Soltesz, MD
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Before heart surgery, you and your family may have questions about the use of blood transfusions.
In certain circumstances, getting a blood transfusion can be lifesaving. However, it is not without risks. Research shows that patients who require blood transfusions don’t do as well as those who don’t receive a transfusion.
In fact, transfusions are associated with more complications, higher mortality, longer length of stay, and a higher likelihood of being readmitted to the hospital. So it’s best to put yourself in a position where you don’t require a transfusion.
What can you do to lower the likelihood that you need a transfusion? Here are some steps to take.
1. Get your blood checked
The best way not to get a transfusion is to come in with a good blood count. Get your blood checked before you come in for surgery, and do what you can to avoid being anemic when you go in for surgery.
If you have a low blood count, talk to your doctor about taking iron or the vitamin folate to give your blood count a boost. Some patients will use erythropoietin, a substance produced by the kidney that leads to the formation of red blood cells in the bone marrow.
2. Be sure you are not taking medicines that cause bleeding
Before surgery, you should temporarily stop medicines that cause bleeding, such as warfarin, which is sold under the brand name Coumadin®.
Most patients who are having heart surgery for the first time can tolerate aspirin well. With second-time procedures, however, it may be best to stop medications that contain aspirin.
If you are taking new-platelet inhibitors, be sure to talk to your doctor about stopping them many days before surgery to prevent bleeding.
Finally, some herbal supplements are known to increase the risk of bleeding during surgery. Remember to tell your physicians about any herbals you are taking too.
3. Ask about surgical approach to reduce blood loss
There are other things that factor into having a blood transfusion that you should discuss with your surgeon. These are things that are done during heart surgery to reduce blood loss.
The approach to surgery is important. We have found over the years that minimally invasive surgery causes less bleeding and chance for blood transfusion. In addition, meticulous surgical technique will result in less bleeding.
Also, we return blood to patients that they lose during surgery. We collect the blood during surgery, which is suctioned into a special canister, cleaned and then returned to the patient.
4. Ask about limiting amount of blood taken for lab work
We noticed that some patients were becoming even more anemic after surgery because of the amount of blood taken during blood draws for lab work.
So we have cut down on need for blood transfusions after surgery by limiting how much blood we take. We now use smaller blood draws and take less blood from each patient.
Remember: blood transfusions can save your life
The vast majority of patients undergoing a primary heart surgery who have a normal blood count, who are not on medications that make them bleed and who are not undergoing extensive surgery are not likely to need a blood transfusion during surgery.
However, it is important to know there are certain operations you cannot do without the need for blood — extensive surgeries and re-operations. In these cases, it may be lifesaving to have a blood transfusion.
So when you are discussing the risks and benefits of surgery with your surgeon, it is also important to understand situations in which a blood transfusion is necessary and appropriate.