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HHS blood conservation coordinator Christa Chernesky checks a patient’s blood pressure. Chernesky’s role includes trying to reduce the number of blood transfusions in hospitals during and after surgery and preserving donated blood.
Christa Chernesky is on a mission to tell people about her role as Hamilton Health Sciences (HHS)’s Blood Conservation Coordinator.
As it sounds, her goal is to try to reduce the number of blood transfusions in the hospital during and after surgery and to preserve donated blood as a precious resource.
“Educating staff and patients is a big part of my focus,” says the registered nurse at HHS’s West End Clinic/Urgent Care Center. Her position as the hospital’s blood conservation coordinator is funded through the province’s Ontario Transfusion Coordinators (ONTraC) program.
“It’s really about optimizing the patient’s own blood so that a transfusion isn’t necessary.”
The aim of the program is to identify patients with anemia (caused by low iron levels) before surgery and treat them with iron supplements so that they do not require a transfusion of donated blood during or after surgery. At HHS, the focus is on heart patients booked for major planned surgeries. Chernesky is currently working to expand the program to all HHS locations, starting with Juravinski Hospital for select cancer patients.
“Cardiac and oncology departments are among our largest users of blood products during surgery,” she says.
Preventing anemia to save blood products
Chernesky is working with doctors and nurses to identify patients who may be anemic, offering these patients further testing and the option of taking oral iron supplements, or in some cases intravenous infusions, to boost their iron levels before surgery.
“It’s really about optimizing the patient’s own blood so that a transfusion isn’t necessary,” says Chernesky. “This would help reduce blood transfusions and conserve donated blood for patients who need it most, such as trauma patients arriving in the emergency department.”
HHS is one of 23 Ontario hospitals with a staff member in this role. These hospitals represent about 70 percent of the provincially used blood.
Although the ONTraC program has been around for 20 years, it’s not well known, says Chernesky, who took up the position of coordinator in June after 14 years of nursing at HHS.
“When I told my colleagues about my new job, many didn’t even know this position existed,” says Chernesky. “I hope to change that by promoting the ONTraC program to staff, physicians and patients with the goal of expanding it as best practice.”
Blood preservation is an evidence-based approach to transfusion medicine, meaning it is based on scientific evidence. It is endorsed by the World Health Organization and represents an international initiative and best practice for promoting bloodless medicine.
“Blood is essentially a liquid organ, and while transfusions with donated blood are generally considered safe, there are some risks.”
Chernesky is working with other healthcare professionals, including members of the blood transfusion team, doctors and nurses, to promote alternatives for certain surgical patients. These patients are at a higher risk of needing a blood transfusion during or after their surgery, mainly because their anemia has gone undiagnosed or untreated.
What is Anemia?
Anemia is a late sign of iron deficiency and causes people to feel tired, have palpitations and shortness of breath. Anemia occurs when a person doesn’t have enough red blood cells, which carry oxygen from the lungs to tissues and cells. The body needs oxygen to survive, so anemia increases the risk of a blood transfusion during or after surgery.
“To protect your brain, heart, and organs, you need more oxygen, so the surgical team will have to give you a transfusion if your blood cells don’t carry enough to begin with,” says Chernesky, who has seen more cases of anemia because the cost of livelihoods and food continue to rise.
Fewer blood donations are available
“Blood is essentially a liquid organ, and while transfusions with donated blood are generally considered safe, there are some risks,” says Chernesky. “About one in 100 people will have a mild reaction such as a rash or fever. About one in 1,000 will have a more severe reaction that can be life-threatening.”
Reducing the number of transfusions helps manage blood supply shortages, especially with the pandemic when fewer people are donating, says Chernesky, who would eventually like to see an organized screening program to test all surgical patients for anemia.
“It would also be better for patients, surgical teams and the healthcare system,” she says. “While implementing a screening program would be costly, there are much higher costs associated with blood transfusions, including longer hospital stays, greater risk of infection and higher mortality.”