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Hepatitis A Outbreak in Michigan Communities
Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus. Public health officials and the Michigan Department of Health and Human Services (MDHHS) are continuing to see an elevated number of hepatitis A cases in Southeast Michigan.
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5-Star Hospital Rating from Centers for Medicare and Medicaid Services
A 5-star rating places McLaren Northern Michigan in the top 2.2% of hospital in the country.

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Blood Conservation

McLaren Health Care is dedicated to providing state-of-the-art medical and surgical care that utilizes a documented, evidence-based approach for the use of blood transfusions in patient care. Every blood transfusion suppresses the immune system to some degree, with additional risks or circulatory overload and other negative events. In 2014 McLaren Health Care teamed with Strategic Healthcare Group in Indianapolis to nurture an evidence-based, blood management program throughout our system. Led by a corporate task force, blood management teams at each subsidiary were educated and trained in new transfusion guidelines to limit the level of risk to patients, improve outcomes and update patient care standards.

Through smarter use of blood products at McLaren, the real benefits are improved safety and updated patient care standards, states Dr. Dennis Spender, Medical Director of the McLaren Medical Laboratory. By using special equipment and methods to reduce blood loss and help your body make more of its own blood, hospitals are finding that patients may recover faster, heal more quickly, have less risk of infection and go home sooner.

What You Should Know About Blood Management and Transfusions

What You Should Know:

  • A blood transfusion is a common procedure in which blood is given to you through an intravenous (IV) line in one of your blood vessels.  Nearly 5 million patients in the U.S. receive a transfusion annually.
  • A blood transfusion may be necessary when the body cannot produce blood fast enough due to major blood loss, destruction of red blood cells, and/or decreased production of red blood cells.  For example, a transfusion may be required to replace blood that is lost during surgery or from an injury, or if an individual is anemic or receiving chemotherapy.
  • Most commonly, a person receives blood from a volunteer donor who has been carefully screened; blood donated from a family member takes much more time to process and the costs may not be covered by insurance; donating one's own blood before a scheduled surgery is rarely the best option because the person becomes anemic and the blood transfusion has many of the same risks associated with blood from a volunteer donor.
  • For some types of surgery, a patient's own blood can be saved during and after the procedure and returned to the patient.
  • Blood management is an evidence-based, multidisciplinary process that is designed to promote the optimal use of blood products for every patient. The goal of blood management is to ensure the safe and efficient use of the many resources involved in the complex process of blood component therapy.
  • Blood management is necessary because blood transfusions are inherently dangerous for patients, poor blood management is extremely costly to providers and the health care system, and because there is a limited blood supply.
  • The latest research and evidence clearly shows that blood management is necessary to ensure the best outcomes for patients, including reducing the risk of infection and complications associated with transfusions.
  • Proper blood management ensures the right dose of blood is given to the right patient at the right time.
  • Patients should ask their physicians about blood management policies at their local hospitals and should always talk to medical professionals prior to scheduled surgeries and procedures.
  • McLaren is engaged in Strategic Healthcare Group's Strategic Blood ManagementTM Initiative to enhance patient safety and maintain the highest quality of care. McLaren is among a select group of hospitals across the nation to use the Strategic Blood Management's system.

Anemia—What is it? - click to expand

A lower than normal number of red blood cells (RBCs) in the blood or a below normal hemoglobin (HEE-muh-glow-bin) is called anemia. Hemoglobin is a protein in the red blood cells that gives the red color to the blood. It also transports oxygen from your lungs to all parts of your body. Because there are fewer red blood cells in anemia, not enough oxygen gets to the rest of the body. This can cause a person to feel very tired along with other symptoms that may get in the way of your daily activities.

Signs and Symptoms

The most common symptom of anemia is fatigue (feeling very tired or weak). Other signs of anemia are:

  • Shortness of breath
  • Dizziness
  • Headache
  • A fast or irregular heartbeat
  • Chest pain
  • Numbness or coldness in the hands and feet
  • Pale skin
  • Irritability
  • Poor concentration
  • Inflammation or soreness of the tongue
  • Brittle nails
  • Odd food cravings (called pica)
  • Decreased appetite especially in children

Note: Anemia often goes undetected because the symptoms can vary from severe to extremely mild and vague.

Causes of Anemia

There can be many causes of anemia. The most common type of anemia is due to iron deficiency. This happens when there is not enough iron in your diet. A lack of certain vitamins (folic acid, vitamin B6, and vitamin B12) in the diet can also lead to a vitamin deficiency anemia. Other types of anemia are hereditary (passed down from parents), like sickle cell disease and thalassemia or can be caused by blood loss from various medical conditions such as heavy menstrual periods, ulcers, surgery, trauma, or cancer.

How do you know that you have anemia?

See your doctor if you’re feeling very tired for unexplained reasons or if you have any of the other signs of anemia (see list above for signs and symptoms). Your doctor will do a physical exam, take a detailed medical history and blood tests, including a complete blood count (CBC). A CBC measures the levels of red blood cells, called the hematocrit (hee-MAT-ohcrit), and hemoglobin in your blood.

If the CBC confirms that you have anemia, your doctor may order more tests to find out the cause, severity, and correct treatment for your condition.

Treatment

The goal of treatment is to increase the oxygen-carrying capacity of the blood. This is done by increasing the number of red blood cells and/or increasing the amount of hemoglobin as close to the normal level as possible. It is also important to treat the underlying cause of the anemia. The treatment will depend on the type, cause, and severity of the anemia. Treatment may include dietary supplements, changes in diet, medicine, and/or medical procedures. In severe cases of anemia, surgery or blood transfusion may be needed.

Prevention

Many kinds of anemia caused by iron and vitamin deficiency can be prevented. You can help avoid this type of anemia by eating a healthy and varied diet that includes foods rich in iron, folate and Vitamin B12. Other kinds of anemia can be prevented or from occurring again by treating the underlying cause, such as bleeding, or by changing a medicine that can cause anemia. Some forms of hereditary anemia, such as sickle cell, cannot be prevented. If you think you may have or be at risk for this type of anemia, it is important to discuss your personal and family history with your doctor and start treatment.

Please call your health care provider if you have any questions, concerns, or think you may have symptoms of anemia or unusual bleeding.

Herbs and Supplements that may affect blood loss - click to expand

Herbs that may increase risk of bleeding or interfere with clotting of the blood.

  • Alfalfa
  • American Ginseng
  • Angelica
  • Anise
  • Arnica Montana
  • Asafetida
  • Aspen bark
  • Bilberry
  • Birch
  • Black cohosh
  • Bladderwrack
  • Bogbean
  • Boldo
  • Borage seed oil
  • Bromelain
  • Capsicum
  • Cat’s claw
  • Celery
  • Chamomile
  • Chaparral
  • Clove
  • Coleus
  • Cordyceps
  • Danshen
  • Devil’s claw
  • Dong quai
  • Evening Primrose
  • Fenugreek
  • Feverfew
  • Flaxseed/flax powder (not the oil)
  • Ginger
  • Grapefruit juice
  • Grapeseed
  • Green tea
  • Guggul
  • Gymnestra
  • Horse chestnut
  • Horseradish
  • Licorice root
  • Lovage root
  • Male fern
  • Meadowsweet
  • Nordihydroguairetic acid (NDGA)
  • Onion
  • Papain
  • Panax ginseng
  • Parsley
  • Passionflower
  • Poplar
  • Prickly ash
  • Propolis
  • Quassi
  • Red clover
  • Reishi
  • Rue
  • Siberian ginseng
  • Sweet birch
  • Sweet clover
  • Turmeric
  • Vitamin E
  • White willow
  • Wild carrot
  • Wild lettuce
  • Willow
  • Wintergreen
  • Yucca
US National Library of Medicine. National Institutes of Health. Med Line Plus Herbs and Supplements, 2006.
*Since, it is difficult to list all the herbs or elements that may affect bleeding, it is important to discuss all over-the-counter supplements that you are taking with your doctor or healthcare provider.

Iron Deficiency Anemia – Use of Iron Supplements - click to expand

Iron supplementation is indicated when diet alone cannot restore low iron levels to normal within an acceptable timeframe. Iron is very important for the production of hemoglobin in your blood and for supplying oxygen to the red blood cells. If your body is low in iron, iron deficient anemia may develop. Your doctor may prescribe an iron supplements for this condition.

How to take

  • Iron supplements are best taken two hours after a meal. Your doctor may recommend that you take iron supplements with orange juice or with a vitamin C tablet. Vitamin C in orange juice or tablet form helps increase iron absorption.
  • If iron upsets your stomach, your doctor may recommend that you take the iron with food or after meals with a full glass of water along with a Vitamin C tablet.
  • Liquid forms of iron should be diluted with water or juice. If liquid iron is recommended, sip the iron through a straw to prevent staining of the teeth.

What you need to know about taking Iron

  • Do eat and/or drink foods with Vitamin C such as orange juice, strawberries, and others. Your doctor may also recommend taking a Vitamin C supplement. Vitamin C helps your body to absorb iron.
  • Do not take iron with milk or eggs. This can limits the absorption of iron.
  • Do not take iron with antacids. It can decrease the effect of iron.
  • Do not drink coffee or tea with a meal or within one hour after. It makes it much harder for your body to absorb the iron.
  • Do not take iron with food products that contain large amounts of calcium such as milk, bran flakes, lentils, potatoes, and oatmeal. Calcium can decrease iron absorption by a third.

Side Effects

Iron supplements can cause constipation, therefore; your doctor may recommend a stool softener or a laxative. Iron preparations can also cause stomach cramps, stomach irritation, heartburn, nausea, and vomiting the first few days as your body adjusts to the medication. Iron almost always turns stools dark green or black. This is due to unabsorbed iron which is a harmless side effect of the supplement.

Call your doctor if you develop severe stomach pains, chest pain, clammy skin, bluish colored lips or fingernails, diarrhea, tarry stools, weak and rapid pulse, or unusual tiredness.

Precaution

Iron preparations are very dangerous for children. An overdose can be fatal. It is important to keep iron supplements tightly capped and away from children’s reach. Any time excessive iron intake is suspected, immediately call your physician or Poison Control Center, or visit your local emergency department.

Preparing for Surgery - click to expand

In preparing for surgery, it is important to be screened for anemia at least 4-6 weeks before your surgery. If you have too few red blood cells, you are anemic. Too few red blood cells decrease your blood’s ability to carry oxygen to the body’s tissues. This causes an increase in the heart and breathing rates in an effort to pump more blood to the tissues. Testing for anemia is done by having a complete blood count (CBC) or a hemoglobin and hematocrit (Hgb & Hct). Your hemoglobin lets you know if your body is making enough red blood cells.

It is important to know if you have anemia before surgery because you will lose some blood during and/or after your surgery. Anemia can affect how you respond to your surgery and how quickly you recover. Anemia if not properly treated, can also affect the functioning of your heart, lungs, kidneys, and brain. In addition, patients who are anemic before surgery are more likely to need a blood transfusion if they lose blood during surgery.

Anemia is present in 35-56% of patients going to surgery (depending on the type of problem they are having surgery for and their overall health). After surgery, anemia is even more common, affecting 90% of patients.

Preparing for Surgery

BLOOD SAFETY PROGRAM | 401 South Ballenger Highway, Flint Michigan 48532 | (810) 342 2179 | mclaren.org What should my Hemoglobin be?

Female: 12-16 g/dL
Male: 13.5-18 g/dL

To reduce your risk for a blood transfusion, your target hemoglobin should be above 13.5 g/dL. The average drop in hemoglobin is 3-4 g/dL for a knee replacement and 4-5 g/dL for a hip replacement.

How can I improve my Hemoglobin?

The recommended treatment plan for building your blood count ideally starts 4-6 weeks before surgery. You need to start taking:

  • Iron (325 mg by mouth per day) is a mineral needed to form red blood
  • Vitamin C (500 mg by mouth taken with the iron) helps with the absorption of iron
  • Folic Acid (1-2 mg by mouth, prescription needed for this amount) helps to stimulate red blood cell production
  • Vitamin B12 (1000 mcg by mouth daily) helps to stimulate red blood cell production

If needed, your doctor may order iron to be given IV and/or a drug called Epoietin alfa (Procrit) by injection to help increase your red count.

Questions to Ask Your Healthcare Provider - click to expand

We are including a list of questions that would be important to ask your health-care provider if you are thinking about having surgery.

  • Will I need a blood transfusion? If so, why?
  • Can you do this surgery without the use of blood?
  • Have you done this type of surgery before without giving blood transfusions?
  • Will your medical team, including the anesthesia division, cooperate with this method of treatment?
  • What type of support can you give medically to ensure I do not need blood? Do you use erythropoietin, volume expanders, cell saver, platelet sealant, and other measures to ensure minimal blood loss?
  • What are the risks if I choose to minimize or avoid blood transfusions?
  • What else do I need to do to prepare myself for surgery?
  • Will I need to increase my blood count for this surgery?
  • What are the risks involved with blood transfusions?
  • If I do need a blood transfusion, how will it affect my recovery time?
  • If my blood count level is low after surgery, how will it affect my ability to resume normal activity?