Blood transfusions during liver transplant operations can now be more guided and accurate, providing patients with improved quality of care and reducing unnecessary waste of medical resources, the Taipei Veterans General Hospital said at a press conference yesterday.
The hospital achieved its improved blood transfusion method using a thromboelastography analyzer (TEG), a device that was first used in liver transplant operations in the 1980s and recently upgraded with new software to increase speed and accuracy, hospital chief of anesthesiology Tsou Mei-yung (鄒美勇) said.
“During major surgeries, massive blood loss may complicate the operation, leading to traumatic or even fatal results. This is especially true in orthotopic liver transplants, where patients, because of their poor liver function, often suffer from coagulopathy [inefficient blood coagulation],” Tsou said.
Traditionally, surgeons and anesthesiologists rely on experience to determine how much blood to transfuse into a patient intraoperatively, Tsou said, adding that medical analyses — including activated coagulation time and platelet count — are also taken into consideration when making a decision.
However, as the tests take up to two hours to conduct, “a lot of times, by the time the test results turn out, the data is already outdated, or the best time for the patient to receive the transfusion has passed,” he said.
In addition, modern research has shown that when a patient needs a blood transfusion, he or she may only need certain components of blood — such as red cells, white cells, platelets and plasma — rather than “the whole blood,” Tsou said.
As the traditional method is not accurate enough, anesthesiogists may administer insufficient or excess blood transfusions, which may in turn have a negative impact on a patient’s well-being, Tsou said.
Based on clinical operations done in the past three years, the hospital has obtained preliminary results to show that TEG-guided blood transfusion may not only aid surgeons and anesthesiologists perform more successful operations, but also save up to 50 percent of medical resources, including the amount of blood and medication used, Tsou said.
“Within 15 minutes, the TEG is able to determine at bedside [during surgery] the three major blood coagulation indexes, as well as how much of which component of blood the patient needs,” Tsou said.
The TEG also monitors patient blood coagulation functions so that drugs can be administered to coagulopathic patients to reduce blood loss, he said, adding that “the administration of blood components rather than a whole blood transfusion also means that a bag of blood can be given to several patients, which stretches blood resources out significantly.”
In the about 60 patients the hospital has treated in the past two years, the average blood loss for patients undergoing a surgery using TEG was about 5,000ml, Tsou said, adding that those operated on without the TEG lost about 11,000ml of blood.
“One patient we treated this year lost only 400ml of blood, which is extremely little for a liver transplant recipient. He therefore did not receive any transfusion,” he said.
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