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Surgeon looks to research to reduce blood transfusions during liver surgery

France Todd Family

France Todd (centre) was part of a pilot study to reduce the amount of blood patients lose during liver surgery and limit their need for blood transfusions.

France Todd’s liver cancer came out of the blue.

“It was one of those flukes,” said the avid downhill skier, CrossFitter, and mother of two. “I went in for my annual check-up and my family doctor found traces of blood in my urine.”

Suspicious spots on an MRI and a biopsy confirmed that she had a tumour.

“My surgeon, Dr. Guillaume Martel, recommended having it removed the following week,” said Todd, who was the director of human resources of a high-tech company at the time. “I was in shock. I knew it would be a big disruption to my life.”

Thankfully, surgery to remove the 4-centimetre tumour went smoothly. Todd did not need a blood transfusion, unlike 25 percent of patients who undergo liver surgery.

Todd was part of a pilot study to test whether taking out 10 percent of a patient’s blood before liver surgery, about the same volume as a blood donation, would reduce their bleeding during the operation.

“We basically removed blood from the patient into a blood donation bag before the surgery, and then put it back in once surgery is done,” said Dr. Martel, a surgeon at The Ottawa Hospital and associate professor at the University of Ottawa. “This technique has been around for a long time. People feel intuitively that it works, but it’s never been rigorously tested.”

The technique is now being investigated in clinical trials, as part of Dr. Martel’s larger research program to reduce unnecessary blood transfusions during liver surgery.

He and his colleagues have also published a tool to help liver surgeons decide when blood transfusions are appropriate. The criteria, based on the latest research and expert opinions, will need to be validated in the clinic.

“Transfusions on one hand are life-saving,” said Dr. Martel. “But on the other hand there are some small risks associated with them, such as infections, allergic reactions, cardiovascular effects and possibly worse cancer results after surgery. We should really be trying to avoid blood transfusions unless they’re absolutely necessary.”

This research was possible because of generous support for The Ottawa Hospital in research to improve patient care. These studies were also supported by the Canadian Surgical Research Fund and the Department of Surgery at the University of Ottawa.


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