Medical Oncologist
CION Cancer Clinics
Bleeding risk during kidney surgery | CION Cancer Clinics
Bleeding is the main risk a kidney surgeon plans around, because the kidney has one of the richest blood supplies in the body. Most nephrectomies finish without a transfusion, but blood is always grouped and kept ready. This page explains where bleeding comes from, who is at higher risk, what the team does to lower it, what a transfusion involves, and the signs after going home that need same-day care. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- How much of a risk is bleeding during kidney surgery?
- Four places a kidney operation can bleed
- What is done before and during the operation
- What to tell your team, and why it matters
- What a transfusion involves, and what this page cannot tell you
- Four things families believe about blood and surgery
- Common questions about bleeding and transfusion
The short answer
How much of a risk is bleeding during kidney surgery?
Bleeding is the main risk a kidney surgeon plans around, because the kidney has one of the richest blood supplies in the body. Most nephrectomies finish without a transfusion, but blood is always grouped and kept ready, and a transfusion during or after the operation is a known possibility rather than a sign of disaster.
Why the kidney is different
A large share of every heartbeat's output passes through the two kidneys. Each one is fed by a thick artery straight off the main artery of the body and drained by a wide vein into the largest vein. Any cut into the kidney, or any slip near those vessels, bleeds fast. That is why the vessels are found and sealed before anything else is done.
Who bleeds more
People on blood-thinning tablets, people with a large tumour or one that has grown into the vein, people who have had surgery in the same area before, and people whose kidney function or blood count was already low. None of these rules the operation out. They change how it is planned.
This page cannot tell you your own chance of needing blood. Ask your surgeon, who knows your scan and your history.Where it comes from
Four places a kidney operation can bleed
Knowing where helps you understand why some operations carry more risk than others.
The main artery and vein
The vessels at the hilum, where they enter the kidney. Sealing them safely is the most careful stage of the operation. A slip here is rare but serious, and it is what the whole approach is built to avoid.
The cut surface in a partial nephrectomy
When only the tumour is removed, the raw kidney tissue left behind oozes until it is stitched. This is why the artery is clamped briefly while the surgeon works, and why the stitching takes time.
Worth asking
- Will the artery be clamped, and for how long?
- Is the tumour near the centre of the kidney?
The large vein, when the tumour has grown into it
Opening the vena cava to remove a tumour plug is the situation where blood loss can be heaviest. Extra units are cross-matched, and a transfusion is more likely than in a standard nephrectomy.
Small vessels in scar tissue
Earlier surgery, infection or a very large tumour can leave the kidney stuck to its surroundings with many small, fragile vessels. Freeing it is slow, and it is often why an operation takes longer than expected.
Tell your surgeon about any previous abdominal or kidney operation, however long ago.Not sure whether this applies to you?
Ask an oncologistHow the team lowers it
What is done before and during the operation
Blood tests and grouping
Your haemoglobin and clotting are checked before the day. Your blood group is recorded and matched units are held in the blood bank, so nothing is searched for in a hurry.
Medicines reviewed
The surgeon, anaesthetist and your own doctor decide together which blood thinners to pause and when. You are told the plan. You never stop them on your own.
Vessels first
Inside, the artery is sealed before the vein and before the kidney is moved. Clips, staplers and sealing instruments are chosen for the size of each vessel.
Watching, and a drain
The anaesthetist tracks blood loss throughout. Before closing, the surgeon checks every surface, and often leaves a drain so any bleeding afterwards shows early.
Before the day
What to tell your team, and why it matters
Tell them if
Because
You take aspirin, clopidogrel, warfarin, apixaban, rivaroxaban or any blood thinner
These need a planned pause, set by the doctors, and some need a bridging injection
You take herbal, Ayurvedic or supplement tablets, including fish oil or ginkgo
Some thin the blood without people knowing it
You bruise easily, bleed long after a cut, or a relative has a bleeding disorder
Extra clotting tests may be needed before surgery
You cannot accept blood for religious or personal reasons
A different plan can be agreed with you well before the day, not decided in theatre
Leave a number, we will call you
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Bleeding after you go home cannot wait
If your urine turns heavily red or you pass clots, the wound or the side swells quickly, you feel faint or your heart races, or fresh blood fills the drain, go to the nearest emergency department the same day and say you have had kidney surgery. Do not drive yourself, and do not wait to see if it settles overnight.
Being straight with you
What a transfusion involves, and what this page cannot tell you
A transfusion means blood from a screened donor is given through your drip, one bag at a time, to replace what was lost. It is decided by the anaesthetist during the operation, or by the ward team afterwards if your haemoglobin falls or you feel faint and breathless. You will be told if it happened.
Its risks, honestly
Donated blood in India is tested for infections before use, and reactions to matched blood are uncommon. A mild fever or rash during a transfusion is the most usual problem and is managed on the spot. Serious reactions are rare. If you have had a reaction to blood before, say so, because a different type of preparation can be used.
What only your surgeon can say
How likely you are to need blood depends on your tumour, your approach and your own history. A page cannot give you that figure. What you can do is ask two questions before the day: how many units are being kept ready for me, and how often does this happen in your hands for an operation like mine.
If you refuse blood on principle, the team can often use techniques that limit loss, but they need to know early.Commonly believed
Four things families believe about blood and surgery
"A family member should donate blood for the operation."
The blood bank supplies matched blood from screened donors, and a relative's blood is not safer. Some banks ask families to donate to replace stock, which is a different thing and is welcome, but it is not needed for the operation itself.
"Needing a transfusion means the operation went badly."
It means blood was lost and replaced, which is planned for in every kidney operation. Many transfusions are given for a low blood count that was already there before surgery, not for anything that happened in theatre.
"I should stop my aspirin myself a week before, to be safe."
Stopping some blood thinners without a plan can cause a stroke or a heart attack, which is a bigger risk than bleeding. The surgeon and your cardiologist set the timing. Take the decision to them, not on your own.
"Keyhole surgery does not bleed."
It usually loses less blood than open surgery, but the same vessels are sealed inside and the same risks exist. A keyhole operation can be turned into an open one to control bleeding, and that is a safe decision, not a failure.
Questions we are asked
Common questions about bleeding and transfusion
How likely is it that I will need blood?
Most standard nephrectomies finish without a transfusion. The chance rises with a large tumour, a tumour plug in the vein, a partial nephrectomy near the centre of the kidney, or a low blood count beforehand. Your surgeon can give you their own figure for an operation like yours.
Can I bank my own blood before the operation?
Some centres offer this, where you give blood in the weeks before and it is stored for you. It is not always possible if your haemoglobin is already low, and it is not needed for most kidney operations. Ask your surgeon whether it is available and sensible for you.
What is a cell saver and will it be used?
A machine that collects blood lost during surgery, washes it and returns it to you. Many surgeons prefer not to use it in cancer operations because of concern about returning tumour cells, so it is not standard for nephrectomy. Ask your team what their practice is.
Will I be given a blood thinner after surgery even though bleeding is the risk?
Often, yes. Lying still after a big operation raises the risk of clots in the legs and lungs, so a small daily injection is commonly given on the ward once the surgeon is happy there is no bleeding. The team balances the two risks and sets the timing.
Why is my blood count low after the operation?
Some blood is lost during any nephrectomy, and the drips given afterwards dilute what is left. A lower haemoglobin for a while is expected. It is checked daily at first, and iron tablets or, less often, a transfusion are used if it falls further or you feel faint.
Can bleeding start days after I go home?
Rarely, but it can, especially after a partial nephrectomy where the cut surface of the kidney can open up. Heavy blood in the urine, clots, sudden pain in the side or feeling faint are the signs. Go to an emergency department the same day rather than waiting for your follow-up.
What if I refuse blood on religious grounds?
Tell the surgeon and anaesthetist at the first appointment. Iron treatment beforehand, careful surgery and medicines that reduce bleeding can lower the chance blood is needed. The team will explain what they can and cannot promise, and the agreement is written into your consent.
Is the blood given in hospital safe from infection?
Every unit from a licensed blood bank in India is tested for HIV, hepatitis B and C, malaria and syphilis before it can be issued. The risk of catching an infection from a transfusion is very small. If you want to know which blood bank supplies the hospital, you can ask.
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Dr. C. Raghavendra Reddy
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- NHS — Blood transfusion
- Cancer Research UK — Surgery for kidney cancer
- American Cancer Society — Surgery for Kidney Cancer
- Macmillan Cancer Support — Blood transfusions
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
What Happens in Theatre During a NephrectomyWhy the vessels are sealed before anything elseNephrectomy With Tumour Thrombus in the VeinThe operation where blood loss can be heaviestMedicines Around Cancer SurgeryHow blood thinners are paused and restarted, and by whomComplications and Red FlagsEvery sign after surgery that needs same-day careUrine Leak After Partial NephrectomyThe other problem the cut surface of the kidney can cause
Talk to us
On blood thinners and facing kidney surgery?
Send us your medicine list and scan report, or call the helpline. A surgical oncologist will tell you what to raise with your team before the day. One helpline serves every CION centre.