Posted by Brigham and Women's Hospital February 18, 2014
John Bain, 71, of Brookline, MA, recently had emergency heart surgery at Brigham and Women’s Hospital (BWH), and his surgical team didn’t need to give him a single drop of red blood. As contradictory as it may seem, it took a lot of donors – and a lot of teamwork – to help make that happen.
While visiting his cardiologist, Dr. Brian Bilchik, in the fall of 2013, John suddenly developed chest discomfort and was transported by ambulance to BWH. Dr. Bilchik ordered a CAT scan, and after examining the test results, told John that he would need immediate surgery to repair an aortic dissection – a dangerous, often fatal heart condition that involves tearing of the aorta’s inner wall. Left untreated, such a tear may quickly advance through all three layers of the aorta and rupture, leading to massive internal bleeding.
Cardiac surgeon Dr. Michael Davidson then stepped in to take John to the operating room for emergency surgery. “I had a CAT scan, and, probably an hour later, I was on the operating table,” recalls John. “It was that quick.”
Adding to the danger of his situation, John had taken an oral anticoagulant (blood thinner) earlier in the day as part of his routine treatment for atrial fibrillation. Although effective for its particular purpose, the newer type of blood thinner John was taking doesn’t have an effective reversal agent.
Physicians anticipated that the medication’s anti-clotting activity would peak during surgery. This scenario was troublesome, as John would need effective blood clotting to avoid excessive bleeding during the operation. But delaying surgery wasn’t a viable alternative, so the surgical team developed a plan to overcome the effects of the medication.
Part of that team was Dr. Jean Connors, Hematology Division, who specializes in treating patients who have blood disorders. She, along with anesthesiologists Dr. Elena Ashikmina and Dr. Annette Mizuguchi, pharmacist David P. Reardon, and perfusionist Nicole Tomasello, oversaw the administration of plasma, platelets, and plasma-derived factor concentrate into John’s circulatory system throughout the procedure. Working in concert, these blood products helped to improve blood clotting, and, in turn, minimize John’s blood loss. At the same time, dialysis was being performed in an effort to filter the anticoagulant out of John’s blood. With six units of red blood (six donors) on standby, John received one unit of platelets (one donor), two units of plasma (two donors), and one unit of factor concentrate (several donors).
Plasma is the clear, watery part of the blood in which red blood cells, white blood cells, and platelets are suspended. It’s collected for use after a whole blood donation has been separated into its main components. Pure plasma, along with helping to maintain blood pressure and balancing body levels of sodium and potassium, contains proteins that play a significant role in blood clotting.
Plasma-derived factor concentrate is composed primarily of these critical clotting proteins. It is produced by separating the proteins from the rest of the plasma components and then pasteurizing the isolated proteins to kill any potential viruses.
Disk-shaped platelets are important for limiting blood loss in that they collect and adhere to each other at the site of a blood vessel injury, forming the foundation of the blood clotting process. At the Kraft Family Blood Donor Center at Dana-Farber Cancer Institute and Brigham and Women’s Hospital, platelets are collected through a process called apheresis. After whole blood is drawn from a donor to start this process, a machine separates the blood into its key components. The platelets are retained, and all the other components are returned to the donor.
The plan worked.
“I didn’t have an ounce of pain after the surgery,” says John. “I couldn’t have been treated any better.”
Ultimately, none of the red blood was ever used, and John’s aorta was successfully repaired. John’s case, however, is a rarity. In many cases of emergency surgery, a significant amount of red blood is required, and, hence, a significant amount of whole blood donors. Yet, his case demonstrates that even when there is minimal blood loss, donation still can play a significant role.
After spending 11 days in the hospital following surgery, John has continued to recover nicely. Along with getting back to work at his family’s antique clock repair shop, he has been exercising daily in an effort to lose weight. John recognizes that thanks to a bunch of plasma and platelet donors, he is now not only a giver, but also a recipient of the gift of time.E-mail BloodDonor@partners.org, call (617) 632-3206, or visit brighamandwomens.org/donateblood to learn more about blood and platelet donation and how you can become a potential lifesaver. – Chris P.