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Transfusion-Free Surgery Goes Mainstream with a Multidisciplinary Team Approach

Keck Medicine of USC is Making Transfusion-Free Surgery the Safe, Smart Choice for Many Patients, Whatever Their Beliefs or Medical Condition

Transfusion-free surgery may sound like an oxymoron, but at Keck Medicine of USC, patients using the Transfusion-Free Surgery & Patient Blood Management Center enjoy a full range of services that reduce or eliminate the need for blood products for a wide range of procedures.

Started as a niche program designed to provide Jehovah's Witnesses with access to transplant surgery, the Center now has an active working relationship with physicians in every area of medicine.

Fernando Fleischman, MD, a board-certified cardiothoracic surgeon with expertise in minimally invasive endovascular techniques and Co-Director of the USC Comprehensive Aortic Center, is devoted to operating with each patient's interests and voice front and center. Providing transfusion-free surgery is often an important part of that.

“At Keck Medicine, we are celebrating the 25th anniversary of our transfusion-free surgery program,” said Dr. Fleischman. “That's proof that with the support of a full program and an experienced team, transfusion-free surgery is possible, even for challenging cases.”

Why Transfusion-Free Surgery Makes Sense

In many situations, the protocols for transfusion-free procedures offer the safest option for any patient, regardless of their beliefs. "Even if you're getting a transfusion from someone of the same blood type, the body sees that as an invader — you might get an immune reaction,” explained Randy Henderson, director of Keck Medicine's Transfusion Free-Program. "The transfused blood can suppress your immune system while your body is trying to recover. Banking and storing your own blood carries risks as well.”

Other factors that contribute to the growing importance of providing expert transfusion-free surgery and patient blood management include:

  1. There are fewer patient complications (such as infections & cancer recurrences) in non-transfused patients, related to the immune suppressing properties of blood products.
  2. Patients may have shorter hospital stays and lower costs, related to fewer complications.
  3. There are often challenges with blood product availability.
  4. The cost of blood products is increasing.
  5. There are decreased hospital reimbursements for resource utilization.

Meet Natalie Ciebrant

Natalie Ciebrant, who is a Jehovah's Witness and cannot receive a blood transfusion and stay true to her faith, was diagnosed with an aneurysm and severe breathing problems. She saw physicians at two major hospitals, but despite the gravity of her condition, she couldn't find a doctor who would treat her.

Then her husband called Alexander Perez, the manager of transfusion-free services at Keck Medicine.

Perez worked to get Natalie into Keck Medicine of USC's Cardiac and Vascular Institute, where she could be seen by the clinicians at the USC Comprehensive Aortic Center quickly. There Dr. Fleischman's expertise allowed him to discover something the other doctors had not: Natalie's aortic root was damaged. It was under pressure and pulling away from her heart, which was why Natalie felt like she couldn't breathe.

“I knew she was high-risk, but I also knew that my team has the skills and experience to do a procedure like this, and we have our whole program here to support us,” said Dr. Fleischman. “If we turned her down, where would she go?”

The Team Process

The next step was to prepare Natalie for surgery. “We have developed a full program for our transfusion-free patients to make sure they are as ready as possible for surgery,” explained Dr. Fleischman.

  • Physically, Natalie prepared for the surgery by taking blood builders: a bone marrow stimulant and a "cocktail" of iron, folic acid (vitamin B9), and vitamin B12 to raise her blood count and correct any anemia.
  • After her blood was optimized, Natalie's blood volume was deliberately decreased to reduce potential bleeding.
  • Then she was scheduled for open-heart surgery.
  • Dr. Fleischman worked cautiously and meticulously, using surgical techniques to avoid the need for transfusion. He repaired the aneurysm and replaced Natalie's aortic root with a graft. "I knew it was going well because there was no bleeding,” Dr. Fleischman says.

Two weeks after they first met her, Dr. Fleischman, Mr. Perez, and the other team members were able to take Natalie into the recovery room to begin enjoying the rest of her life. “Challenging cases like this remind us that there is almost always a way forward,” said Dr. Fleischman.

“Everyone deserves access to the best possible care; our mission is to make sure they get it.”

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