I have been performing brain surgery for many years. Patients often ask, “Doctor, is it okay for us not to have blood transfusion during surgery? In fact, it is difficult for doctors to answer such a question.
It is not the surgeon’s personal decision whether blood transfusion is needed in brain surgery. The factors that determine whether blood transfusion is needed are: the patient’s physical condition; the amount of blood loss during surgery. For patients with weaker constitution, it is advocated to consider blood transfusion more actively intraoperatively. For example, patients with low preoperative hematocrit, elderly patients, and pediatric patients.
The amount of intraoperative blood loss is a decisive factor in considering whether to transfuse. In general, an adult patient with intraoperative blood loss of no more than 400 ml generally does not require transfusion, and transfusion should be considered if it exceeds 800 ml. The amount of blood loss is related to the type of lesion and the surgeon’s skill. For example, if the tumor is huge and the blood supply is rich, the amount of bleeding may be more, while experienced and skillful surgeons are more adept at controlling the amount of bleeding.
During surgery, it is the anesthesiologist who makes the decision on whether or not to give a blood transfusion and carries it out. The anesthesiologist will make a comprehensive assessment of the patient’s physical condition, the amount of blood loss, and decide whether to transfuse or not. The attending surgeon may also give a recommendation on whether to transfuse. Mature anesthesiologists will usually initiate communication with the primary surgeon, especially when performing major surgery.
The biggest consideration for a patient who does not want a blood transfusion is the possibility of contracting a disease from the transfusion. But in fact, the probability of infecting diseases with blood transfusion is very low and basically negligible. For brain surgery, maintaining blood volume balance is usually more significant than for other types of surgery because the brain is particularly sensitive to ischemia and hypoxia. The brain weighs 3% of the body weight, while cerebral blood flow accounts for 15% of systemic blood flow.