Study Finds Removing Blood Prior to Liver Surgery Reduces Transfusions

Blood transfusions are a common yet challenging aspect of major liver surgery, with up to one-third of patients requiring them due to significant blood loss. A groundbreaking clinical trial, published in The Lancet Gastroenterology & Hepatology, has demonstrated that removing 10% of a patient's blood prior to surgery—a technique called hypovolemic phlebotomy—can cut transfusion rates by half. This innovative approach, researchers argue, is simple, safe, and cost-effective, offering benefits for patients and healthcare systems alike.

Reducing Blood Loss with a Simple, Effective Technique

In the largest trial of its kind, 446 patients undergoing major liver surgery at four Canadian hospitals were randomly assigned to receive either hypovolemic phlebotomy or standard care. For those in the intervention group, anesthesiologists removed approximately 450 mL of blood before surgery and returned it to the patient either during the procedure (if needed) or afterward.

Only 7.6% of patients in the hypovolemic phlebotomy group required transfusions within 30 days of surgery, compared to 16.1% in the usual care group. Moreover, median blood loss during surgery was reduced. The study found no increase in complications associated with the technique.

“It works by lowering the blood pressure in the liver. It's safe, simple, inexpensive, and should be considered for any liver surgery with a high risk of bleeding,” explained co-lead author Dr. Guillaume Martel.

The Bigger Picture: Saving Resources and Improving Patient Safety

Blood is a limited and expensive resource, with a single transfusion costing at least $500 CAD in Canada. By contrast, the materials required for hypovolemic phlebotomy cost less than $30 CAD.

“Blood transfusions can save lives, but if you don't need one to save your life, then it's better to avoid it,” noted Dr. Dean Fergusson, senior author of the study. “Blood is a precious and limited resource that we need to preserve as much as possible for those who need it most.”

The practice has already become standard in the trial’s participating hospitals and is being considered for wider adoption worldwide. Researchers are also exploring its potential use in liver transplants and other surgeries involving significant blood loss.