Blood Conservation Program

Contact the Heart Center

What is the Blood Conservation Program?

At Seattle Children’s Heart Center, our Blood Conservation Program provides safe, effective heart care for your child with less need for blood products or a blood transfusion. In many cases, we can do bloodless surgery — surgery without using any stored or donated blood products.

We routinely use methods to limit or avoid the need for blood products for all children who come to the Heart Center. We also work closely with families who prefer that their child not receive blood products or transfusions for religious, cultural and personal reasons.

Seattle Children's has the most advanced pediatric Blood Conservation Program in the country, for all cardiac conditions.

What is blood conservation?

Blood conservation means using methods to limit blood loss during surgery. It is the standard of care for all patients at Seattle Children’s. Methods to limit blood loss can help reduce the need for stored or donated blood products.

What is bloodless surgery?

Typically, doctors have used stored or donated blood products to:

Replace blood that a child loses during or after heart surgery
Prepare (prime) a heart-lung pump to circulate a child’s blood during surgery
Increase a child’s blood volume so the heart-lung pump can support the child more easily

For certain surgeries, the use of stored or donated blood products is the standard of care and is thought to be safest for the child. However, surgery can also be done without the use of stored or donated blood. This is called bloodless, no-blood or transfusion-free surgery.

Based on your child’s needs, bloodless surgery may be a safe option.

What are the benefits of bloodless surgery?

Health risks of receiving blood products are low. But if your child doesn’t receive any stored or donated blood products at all, there’s zero risk of:

Getting an infection from a donor’s blood
Having a reaction, such as an allergic reaction, to a donor’s blood
Having the donor’s red blood cells destroyed by your child’s immune system (hemolytic transfusion reaction)

Your child’s immune system may also be stronger as they recover, and they may recover faster, if they have bloodless surgery.

If you have religious, cultural or personal reasons for avoiding blood products, bloodless surgery offers a way for your child to get care that aligns with your wishes.

What’s special about the experience at Seattle Children’s?

Seattle Children’s Heart Center is dedicated to giving each child the best medical and surgical care with innovations like bloodless heart surgery. If you are choosing a hospital for your child’s heart surgery, we are happy to talk with you in advance about doing bloodless surgery here. Call the Heart Center at 206-987-2515.

When you come to Seattle Children’s, your child will be treated at one of the nation’s top Heart Centers, as ranked by U.S. News & World Report.

Our focus is on safety

Your child’s health is always our top priority. Our goal is to lower the risks of surgery for your child by limiting or avoiding blood products or transfusions when we can.
Blood products and transfusions are used safely in millions of people each year, but they are not completely risk-free. tend to be better in patients who do not receive blood.
We are experienced with many different methods to conserve blood during your child’s care. Most are the standard for all our heart surgery patients, like doing fewer blood draws. Others will be part of your child’s treatment plan if needed, like giving them iron supplements to boost their .
The Heart Center follows standard guidelines about when children need blood products or transfusions. If your child does need these measures, we will give them. We do not withhold blood products or transfusions if doing so would put your child at risk.
We follow practices, like giving only as much blood as your child needs and giving a transfusion later in the surgery instead of earlier. Steps like these help improve outcomes for patients.

Care custom-made for your child

We will plan and perform your child’s heart surgery to conserve blood and reduce the need for blood products and transfusions. Multiple studies of bloodless surgery show that it is at least as safe and effective as surgery using stored or donated blood.
Your child’s team will work closely with you to decide on treatment that is right for your child, taking into account your beliefs and values.
Before surgery, we will ask you to consent to procedures your child will need or might need. If you object to transfusions, we will talk with you about bloodless surgery options in order to understand, record and follow your wishes whenever possible.

Team-based approach for the best results

Bloodless surgery requires the skills of many experienced specialists working as a team. Seattle Children’s has the most experienced pediatric cardiologists and heart surgeons in the Pacific Northwest.
Our surgeons have done complex heart surgeries using bloodless methods. They helped design many of the processes and techniques that other hospitals use around the country.
Our expert carefully check and manage blood flow and breathing for children on a heart-lung pump. Their training and experience are essential for bloodless surgery.
Many more team members will be part of helping to conserve your child’s blood and avoid use of blood products. They include your child’s , , , , nurses and others.

Advancing bloodless pediatric heart surgery

The trend toward blood conservation and bloodless surgery started with adult patients. Seattle Children’s is a leader in bringing the same advances to pediatrics. This requires special knowledge and skills because children have less blood to begin with. The smaller they are, the less blood they have. People with less blood are more likely to need blood products.
In recent years, we have expanded our blood conservation efforts. This has helped us avoid transfusions for many more patients, even the smallest children. From May 2020 to May 2021, we avoided transfusions for about 2 out of every 100 patients under 26.5 pounds (12 kilograms) who had open-heart surgery. A year later, after expanding our efforts, the number improved to 20 out of every 100 patients.
We are among a small number of hospitals that can limit or avoid blood products and transfusions in newborns, whose volume of blood is much lower than in an adult.
Typically, all newborns need a transfusion during their heart surgery or hospital stay, according to data from more than 80 hospitals across the country. In cases where we tried to do bloodless surgery for newborns, 25% of our patients avoided a transfusion during their surgery or stay at Seattle Children’s.
For babies who need a heart-lung pump, Seattle Children’s uses a microcircuit. This special machine can support babies by circulating their small amount (volume) of blood, often without the need to add blood products from a donor.

Methods We Use for Blood Conservation

To lower the chance that your child will need blood products or a blood transfusion, we may use a wide range of methods, including these:

Nutrition and medicines, such as iron supplements, to improve your child’s blood cell levels before and after surgery
Fewer blood tests before and after surgery so we are only taking blood from your child’s body when tests are truly needed
Smaller incisions and less cutting through tissue so your child loses less blood
Changes to how we set up your child’s heart-lung pump so it uses less blood
Cell Saver technology to collect, clean and return lost blood to your child during surgery
Products (not made from blood) that we can put on an incision to help control bleeding
Albumin to adjust your child’s blood volume
Acute normovolemic hemodilution to limit loss of blood cells
Special steps as your child recovers after surgery in the intensive care unit, like taking out their breathing tube as soon as it is safe so they can get nutrition by mouth instead of through an intravenous (IV) line

What to expect

Before your child’s surgery, we’ll talk with you about the details of their procedure and about using or not using blood products. We’ll also tell you about ways to reduce the need for blood products. For example, your child’s doctor may suggest supplements or diet changes to raise your child’s iron level. Or the doctor may use a medicine to boost your child’s red blood cells. They may also suggest stopping certain medicines that can increase bleeding.

It’s common to need some blood tests before heart surgery. Your child’s team will make a plan to take as little blood as possible to keep your child’s blood level up.