Foods rich in iron and regular exercise can minimise the need for a blood transfusion during an operation, anaesthesiologists said, as Hong Kong’s blood bank faces a shortage amid the coronavirus pandemic.
The approach of boosting and conserving one’s own blood, known as patient blood management, could also shorten the duration of a hospital stay by half, and reduce the chance of needing a blood transfusion by two-thirds, according to a local hospital study conducted between 2015 and 2017.
“During the Covid-19 pandemic, (because of) the needs of social distancing, the frequency of blood donation has dropped,” said Dr Chow Yu-fat, president of the Hong Kong Society of Clinical Blood Management and an anaesthesiologist from Queen Elizabeth Hospital.
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“Patient blood management could … reduce one’s dependence on blood products in such a situation.”
Fewer people have donated blood during the pandemic, and between April and July, the Hong Kong Red Cross Blood Transfusion Service made two urgent appeals as blood inventories dropped to “very low levels”, with only three to four days’ stock.
Presently, the inventory remains at a low level, meaning there is enough stock for five to six days.
And even without the virus, the supply could become unstable in the long run because of the city’s ageing population, according to Dr Cheng Hung-kai, a consultant in the department of anaesthesia at Tseung Kwan O Hospital.
Cheng said demographic changes could mean more people need a blood transfusion as older people are more likely to require the procedure, while fewer young and healthy individuals would be around to donate blood.
Chow and Cheng are among a group from the society calling for a wide range of measures to reduce the need for blood transfusions, a procedure that can lead to less favourable clinical outcomes. Details of the recommendations were published on Monday in the latest issue of the Hong Kong Medical Journal.
“Among developed places, Hong Kong has a relatively higher rate of blood use as we begin the concept of patient blood management at a later stage,” Cheng said.
According to figures provided by the doctors, the blood demand in Hong Kong was around 25 to 30 units per 1,000 people, compared to the rate of 20 to 25 in countries such as Australia, and the Netherlands.
Dr Cindy Tsui Sin-yui, an anaesthesiologist from Princes of Wales Hospital and a co-author of the journal article, said a diet with more iron-rich food, such as spinach or red meat, ahead of surgery could reduce the need for a transfusion.
Such foods can increase a person’s haemoglobin, a protein in red blood cells that carries oxygen in the body, and gives blood its red colour. Having food high in Vitamin A and C can also enhance absorption of iron, she added.
Doing regular exercise before the operation would also help reduce bleeding and complications after operations, Tsui said.
“There are things we could do in our daily lives … the body will recover better and reduce the need for blood transfusions and the risk of complications,” she said.
A group of 168 patients from Tseung Kwan O Hospital, who underwent colorectal tumour removal surgeries between November 2015 and June 2017, were found to have faster recovery time when adopting this approach before their operations, according to Cheng.
On average, those patients only needed to stay in hospital for four days, compared to eight days for those who did not prepare their body beforehand.
The proportion of those requiring a blood transfusion during surgeries also dropped to 11 in every 100 people, in contrast to around 33 in the past.
Cheng said patients who underwent operations that might lead to more blood loss, such as knee replacements, or gynaecologic surgeries, could also benefit from this approach.
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