New liver surgery technique to reduce the need for transfusions

Taking 10% of a patient's blood before major liver surgery, then re-transfusing it during or after the operation, can halve the number of transfusions required, a team of Canadian and Quebec researchers has demonstrated.Known as hypovolemic phlebotomy, this practice minimizes bleeding during surgery and could help preserve blood bank reserves by preventing the one in 11 patients who undergo this surgical procedure from subsequently requiring a transfusion.“The technique has been known for several years, but it's underused and understudied,” said study co-lead author Dr. Guillaume Martel, the Vered Family Chair in Hepato-pancreato-biliary Research at the Ottawa Hospital and the University of Ottawa.“There are parallels in other medical fields. In trauma surgery, for example, if you fill patients (who are bleeding heavily) with blood products too aggressively, they're going to bleed a lot more. So, if we want to, we need to control hypovolemia.”Between 2018 and 2023, Dr. Martel and colleagues from the Centre hospitalier de l'Université de Montréal, the Centre hospitalier universitaire de Sherbrooke and Vancouver General Hospital, recruited 446 patients undergoing major liver surgery at four Canadian hospitals. Once under anesthesia, patients were randomized to hypovolemic phlebotomy or usual care. If necessary, patients in the first group first received the blood that had been drawn from them.The data showed that 7.6% of hypovolemic phlebotomy patients received blood transfusions within 30 days of the operation, compared with 16.1% of those receiving standard care.The average volume of blood lost during the operation was estimated at 670 mL with hypovolemic phlebotomy, compared with 800 mL with usual care. Surgeons therefore feel that this procedure facilitates their work, since there is less blood to obscure the areas to be cut.“This is a major breakthrough in our field,” said Dr. Martel. “I was amazed by the magnitude of the difference.”Collecting half a litre of blood, the equivalent of a blood donation, just before major liver surgery is “the best thing we've found” so far to reduce blood loss and transfusions, added Dr. Martel. "It's a safe, simple and inexpensive procedure that lowers blood pressure in the liver.”Several strategies have been tried over the years to control bleeding during surgery, with mixed success, he said. “But in my opinion, this is the first time we've had such a large and obvious effect.” Rates of transfusionsIt is estimated that between a quarter and a third of people who undergo major liver surgery will require a transfusion. Cancer is the most common reason for these operations and receiving a transfusion during or shortly after surgery may be associated with a higher risk of the cancer returning.“We really want to avoid unnecessary transfusions.” Dr. Martel's team has already tested hypovolemic phlebotomy in major liver surgery in a Phase 1 trial at the Ottawa Hospital. The procedure is now being tested in liver transplantation, and there may be interest in testing it in the future for other surgeries involving significant blood loss. The findings were published in the medical journal the Lancet Gastroenterology & Hepatology.

New liver surgery technique to reduce the need for transfusions

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