For many years, the medical community worked under the assumption that blood transfusions were beneficial to patients. Recent clinical research, however, shows that blood transfusions potentially increase the risk and rate of complications. This is especially true with surgical procedures. Accordingly, Dr. Kaper takes substantial strides to reduce the potential need for blood transfusion in his surgical patients.
Preoperative Patient Evaluation
Dr. Kaper carefully evaluates his patients prior to surgery. The goal is to identify patients who may be anemic (defined as a low Hemoglobin and Hematocrit level). These patients may be at risk for needing a blood transfusion during or after surgery. Patients are treated aggressively prior to their surgery – to minimize the risk of transfusion.
Prior to surgery, all blood thinning-type medications or over-the-counter (OTC) supplements are stopped. This includes medications such as: Coumadin or Warfarin, Xarelto, Plavix or Clopidogrel, Pradaxa, Eliquis, Effient or Aggrenox. OTC supplements such as Vitamin E, Garlic, Ginseng, and Gingko can also increase bleeding risk.
Preoperative treatment routinely includes the use of oral iron (ferrous sulfate) supplements – 325 mg twice daily usually starting 4 weeks prior to surgery. Intravenous iron supplements are now also being recommended for certain patients.
For patients identified to be anemic prior to surgery, usually defined as a Hemoglobin (Hgb) level of 12 or less, Erythropoietin (also known as EPO or Epogen) can be prescribed prior to surgery. This medication is usually administered as a weekly injection for the 3 weeks leading up to surgery. Epogen is a medication originally developed to treat anemia in cancer patients. Its use prior to surgery can stimulate the human body to produce more red blood cells, the cells necessary to carry oxygen throughout the body. If a severe case of anemia is identified prior to surgery, it is usually recommended that surgery be postponed. This allows for thorough evaluation and treatment of the cause of the underlying anemia.
In the Operating Room
In the operating room, Dr. Kaper employs the latest surgical techniques to minimize the trauma of the surgical procedure, which reduces blood loss for the patient. It has been shown that the type of surgery performed and the skill and experience of the surgeon are important factors that can influence the potential need for blood transfusion. Special medications, known as “anti-fibrinolytic agents”, (Tranexamic Acid or Amicar) are used in the OR to reduce bleeding during and after surgery. Multiple recent clinical studies have shown the dramatic benefit of these medications to reduce the need for blood transfusions.
The overall goal, therefore, is to address the concern about blood transfusion at every step along the surgical path. Dr. Kaper’s goal is to be able to perform a patient’s surgery as efficiently as possible. Surgery is performed with the least amount of blood loss – thereby avoiding any need for blood transfusion. The result is a lower rate of complications with improved surgical outcomes.