Blood Management

Also known as: Blood Conservation

Blood management focuses on strategies to reduce or avoid the need for blood products for all patients, and helps coordinate the care of adult patients who choose not to receive blood products under any circumstances.

Blood conservation

Blood conservation is the process of conserving enough of your own blood during medical or surgical treatments and procedures to reduce or eliminate the need for a blood transfusion. There are many patients who require blood transfusions due to anemia, cancer treatments and surgery.

During blood conservation, various techniques are used to conserve blood, control bleeding or promote the growth of new blood cells. Some of these techniques include vitamins, medications, and micro-sampling, where only a minimum amount of blood is taken for testing.

Reducing unnecessary transfusions

Providence reduces unnecessary transfusion of stored blood products by:

  • Providing planned utilization of blood, blood products and available alternatives that optimize patient outcomes
  • Supporting an informed consent process which addresses legal and ethical concerns even if the patient refuses blood for religious or personal reasons
  • Following principles of evidence-based practice to appropriately measure outcomes of various blood conservation strategies
  • Increasing patient satisfaction and safety in the transfusion process

Most medical professionals acknowledge there still is a place for blood transfusions in medical care. Transfusions can be an essential tool in the recovery of patients with certain diagnoses and in situations where time does not allow the use of alternatives.

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Providence St. Peter Hospital Anticoagulation Clinic

Providence Pediatric Hematology Oncology - Spokane

Providence Centralia Hospital

Providence St. Peter Hospital

Marysville Clinic

Providence Regional Medical Center Everett

Providence Sacred Heart Medical Center

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Providence Regional Medical Center Everett

Laura Bischel, BSN, RN
Blood Management Specialist

Sacred Heart Medical Center
Download the refusal of blood form

If I'm anemic and I don’t want to take a blood transfusion, what other alternatives are there available to me?

For general purposes, we always recommend that you talk to your primary care provider about your options. Not all options are applicable to every patient. However, here are two options you may want to consider.


In order to efficiently produce red blood cells, the body needs certain levels of folate, B-12 and iron. Note that there are some conditions in which these supplements can be harmful. Always talk to your physician before taking supplements.

Erythropoietin (Epogen, Procrit, EPO)

  • Synthetic human protein normally produced in the kidneys, now chemically produced in a lab
  • Stimulates bone marrow to make more red blood cells
  • Conscience matter only because it contains a small amount of albumin used to stabilize it (pertains to United States health care only)
  • Takes 2-4 weeks to show effectiveness
  • Expensive; make sure billing and insurance issues are addressed
  • If your faith normally objects to a blood transfusion, this is considered a “conscience matter and a fraction”

I'm having surgery soon and want to avoid transfusion if possible. What type of tools or techniques does Providence provide for surgical patients who want to avoid a transfusion?

  • Davinci Robotic Surgery®
  • Aquamantys®
  • ConstavacTM
  • Electrocautery
  • Harmonic scalpel
  • Cell Saver
  • Pre-operative assessment and red blood cell optimization
  • Post-operative blood management consultation available for physicians who want to avoid transfusions for patients 

Cell salvage is a commonly used procedure in blood conservation. There are also some diagnostic or treatment procedures that use your blood as well.

Here are some examples of blood conservation procedures:

Cell salvage

When blood is lost in the operating room from the surgical incision, the blood is suctioned up by a plastic tube. It then enters vacuum tubing to a machine that can best be described as a blood “washing machine,” exiting the device through tubing and into a bag. As the bag fills, it is raised up and the cleansed blood it holds is given back to the patient. This all happens within a matter of minutes. This can be done with only brief interruptions in connections and flow for a matter of seconds. Other forms of cell salvage are gravity fed instead of suction; the same principle applies with filtration and reinfusion.

Acute normovolemic dilution

This technique is sometimes used as a tool for the anesthesiologist and the surgeon to reduce the loss of the patient's red blood cells. It is usually used in procedures where the surgeon feels there is a potential for large blood loss, such as total hip replacement, or vascular aneurysm repair. At the beginning of the procedure, a large amount of blood is allowed to leave a vessel into tubing from the patient while at the same time a large amount of intravenous fluids is being delivered to the patient.

At all times, the patient is monitored very closely by the anesthesiologist to maintain a good blood pressure and oxygenation. During the procedure, the patient is losing diluted blood while the more concentrated fresh blood that was removed earlier has been temporarily diverted (while still connected) through circuitry and bags. Near the end of the surgical procedure, the anesthesiologist returns the attached collection of blood to the patient.

Cell tagging

This is a test done to assist in diagnosing the location of blood flow to an object or area. A small amount of the patient’s blood is removed from a vein, mixed with a radioisotope, and reinjected into the patient so it can “illuminate” the path of the cells and watch them travel to the area of concern.

Blood patch procedure

This spinal procedure is done to repair or assist in repairing a small hole or tear in the membrane that acts as a sealant around the spinal space. A small amount of blood is withdrawn from a vein in the patient and is immediately injected into the area where the small hole exists. The blood is injected into a region to help clot and plug the hole that is leaking non-blood fluid around the spinal column.

Cardiopulmonary bypass (CPB), hemodialysis (HD), aphaeresis

These are external circulating devices used in the care of patients with various diseases.

  • CPB is frequently used when a patient’s heart needs to be operated on. It does the work of the patient’s heart and lungs so that these organs can be at rest during the surgical procedure.
  • HD is used to cleanse the patient’s blood of toxins when the patient’s kidneys are not able to do the job.
  • Aphaeresis is a procedure where specific parts of the patient’s blood is being filtered or replaced.

All of these techniques are done by way of venous or arterial access into the patient’s body through tubing and circulates outside the body. The tubing then returns the altered blood to the patient. These are considered "closed circuitry" procedures.

Blood removal from veins or reinserting blood drawn from patient tubing

Blood that is withdrawn for laboratory tests is disposed of after testing. If you are a patient who for personal or religious reasons would refuse a blood transfusion at any cost, the lab may use different procedures when drawing your blood to avoid any unnecessary losses. If you are hospitalized, be sure to mention to the person drawing your blood that you would like transfusion-free care so that they can flag you on an ID board in the lab. They will also notify the nursing staff to place identifiers on your chart and at the head of your bed for future lab personnel.

When patients need to have blood removed from intravenous tubing due to difficulty with vein access or frequency of draws, some patients get concerned. Blood conservation minded centers attempt to utilize devices that waste the least amount of blood possible.

You may see your bedside caregiver draw large amounts of blood and have it diverted into a chamber attached to you while they draw even more blood that is placed into a vial for the laboratory. They will then reinfuse the original blood into your body. This prevents a large amount of wasted blood, and also supplies them with a clean blood sample that is not contaminated with IV solution or medications in the line. If you are concerned about this diversion, talk to your health care representative or ask to speak to the Blood Conservation Coordinator about this procedure.

I have an advance directive and/or a durable power of attorney for health care, but it doesn’t say anything about blood transfusions. What should I do?

It's always wise to mention your specific wishes concerning blood transfusions and receiving blood products on your document in clear and precise language. This document speaks for you when you can't speak for yourself.

Your designated health care agent (the person you designated to guide decisions if you are unable to) can't change any of your choices that are documented on this form, so make sure he/she understands your wishes.

Who needs to have a copy of my advance directive?

Your designated health care agent needs to have a copy as well as your primary care provider. Be sure to give them a new copy any time you make any changes, no matter how minor you think they may be. Also consider giving a copy to a family member or close friend. Be sure to bring a copy of your advance directive any time you are hospitalized or when you see a new provider for care.

My advance directive mentions “fractions” of blood. What does that mean? Are fractions the same as a blood transfusion and where do they come from?

Learn more about fractions of blood.