Researchers from Unifesp (Federal University of São Paulo) implement a program in Brazil to reduce the use of blood bags during surgeries and, therefore, reduce rates of infectioncosts, mortality and hospital stay.
The patient’s blood management program (PBM) recommends strategies to avoid fluid loss – and, if it occurs, reuse it.
In one year of application, according to Unifesp, PBM reduced hospital infections by 10%, deaths by 11% and the average length of stay in ICUs at Hospital São Paulo, a public unit of the university, by three days. The savings exceeded R$4 million.
PBM views blood as a organ as important as the others, and not just as a replacement fluid. The model was detailed in a global guide released by WHO (World Organization of Health) in 2025 and reviewed by 100 scientists, including researcher Isabel Cristina Céspedes, from Unifesp.
THE SheetCéspedes states that PBM gains importance in a context of blood scarcity, a problem for public health overcome in the years to come. But not only. THE science has gathered signs that transfusion can be a harmful process to the patient’s health.
“With the population agingpressure on blood supplies has grown. This is an important health problem. We routinely cancel surgeries due to lack of blood”, explains the researcher.
To start a surgery, for example, the doctor needs a supply of blood; an emergency reserve for any adversity. Due to lack of scholarships, elective surgeries can be cancelled.
“We have studies showing that this account will close less and less. We have observed an increase in chronic diseases in the population, and a reduction in donations. At the same time, we have surgeries, such as oncology, that cannot be postponed”, he states.
Blood plays an important role in clinical processes, hence the need to look for alternatives to reduce dependence.
According to Céspedes, geneticists began to look at a factor beyond the lack of bags: the loss of blood quality. They then proposed considering transfusion as a transplantas important as a kidney, for example.
“Molecular science suggests that transfusion patients have a greater chance of hospitalization and more deaths. When looking at the bag, it was discovered that there were several elements there that cause inflammation. Therefore, a donor’s blood has an aggressive impact on the recipient’s body, mainly inflammatory and immunosuppressive”, he explains.
This discovery suggests avoiding placing one individual’s cell inside another.
Scientists also observed that, after three hours, cells present in a blood bag begin to gradually degrade. As a result, they release intracellular content, such as mitochondrial DNA.
When a person receives blood that has undergone this process, the body interprets that it is suffering cellular aggression. From there, an epigenetic effect occurs, that is, a change in the recipient patient’s genes.
The thesis worked on by Céspedes earned Unifesp an international award, and endorses the importance of PBM.
Steps
PBM is organized into 38 strategies and three pillars.
The first is pre-operative: a specialist will analyze the blood and prescribe medications to increase cell reserves. He will also take care of pre-existing anemia and check that there are no clotting disorders. It’s about taking care of the blood, making it stronger.
“When the patient goes into surgery, they will have a reserve to lose, and they will probably not need a transfusion”, explains Céspedes.
Then, the intraoperative stage begins, which consists of prioritizing good surgical practices, adopting less invasive procedures and with fewer incisions. At this stage, the use of hemostatic medications is adopted to contain bleeding.
Also at this stage is the use of intraoperative recovery equipment, a sucker that collects the blood leaving the surgery, washes it, centrifuges it and filters it. Then, fill a new bag with the patient’s own blood.
The last stage, post-operatively, consists of giving the patient time to recover, without receiving blood from the donor.
According to Céspedes, a transfusion for the SUS (Unified Health System) costs around R$600. Medications to prepare the patient, for example, cost between R$100 and R$150. The other equipment used in the PBM is already available in the public system.
Furthermore, when receiving their own blood, the patient becomes less inflamed and tends to recover faster, reducing hospital stay costs.
Currently, PBM is taken by Unifesp researchers to hospitals in the states of São Paulo and Maranhão. There are negotiations to also take it to Minas Gerais and Amapá.
In addition to Céspedes, the PBM incorporation team in Brazil is made up of professor Jaquelina Sonoe Ota Arakaki; by neurosurgery professor Manoel Antonio de Paiva Neto; by anesthesiologist Pierre François Georges Schippers and hematologists Maria Stella Figueiredo and Melca Maria Oliveira Barros.
