Underused Blood Conservation Technique Significantly Reduces Transfusion Needs in Heart Surgery

A recent study from the University of Oklahoma, published on September 3, 2025, in JAMA Surgery, highlights the potential of acute normovolemic hemodilution (ANH) as an effective blood conservation strategy during heart surgeries. ANH involves collecting a patient's blood before initiating cardiopulmonary bypass and reinfusing it near the end of the procedure. Despite its proven benefits, ANH remains underutilized in the United States, with only 14.7% of relevant cases employing this technique. However, the research revealed that patients who received ANH had a 27% lower chance of requiring blood transfusions, which could lead to significant cost savings and optimize resource utilization while maintaining patient safety.

The demand for cardiac surgeries is rising globally, with over a million procedures performed annually. In high-income countries like the US, blood products are heavily used in these operations, with up to half of the patients needing transfusions. Lead author Dr. Kenichi Tanaka emphasizes that integrating ANH more widely could reduce the reliance on donated blood, which is costly and resource-intensive to process. Blood transfusions, though seemingly inexpensive, incur multiple steps involving testing and typing, with associated costs nearly three times higher than the purchase price of blood itself.

In addition to reducing transfusion rates, ANH was associated with a decrease in platelet usage. This is particularly beneficial since platelets can lose functionality if stored for too long, especially in patients on aspirin therapy prior to surgery. The study, which analyzed data from 16,795 patients across 52 sites, found that ANH was performed in 28 centers, representing just 14.7% of cases. Nonetheless, the lack of a standardized protocol for blood volume removal and fluid management during ANH posed some limitations.

Dr. Tanaka advocates for continued adoption of ANH and future research to explore combining this technique with clotting factor concentrates to further minimize transfusion requirements. He emphasizes that even small reductions in blood use can substantially impact healthcare costs and blood supply, especially amid declining blood donations and rising blood component expenses.

This study underscores an important shift toward resource-efficient practices in cardiac surgery, with potential benefits for patient outcomes and healthcare sustainability. Source: https://medicalxpress.com/news/2025-09-underused-blood-technique-odds-transfusion.html