Dr. Thomas Kickler, an expert in bloodless surgery as well as conventional,
transfusion-based methods, answers common questions about bloodless health
Bloodless medicine and surgery is preferred by individuals who have religious
convictions that exclude the use of stored blood products. Besides adhering
to an individual's religious beliefs, are there other reasons why bloodless
surgery might be the preferred method?
Some patients cannot receive blood transfusions because their bodies have
already made antibodies against the markers found on some red blood cells.
This means that if they are given red blood cells with these markers, their
antibodies will automatically attack and destroy the transfused red blood cells.
The medical consequences of this reaction (called alloimmunization) can be
very serious. It may not be possible to find fully compatible donor blood that
will not provoke this reaction.
Other patients are concerned about the risk of disease transmission and refuse
What conditions are particularly amenable to bloodless techniques?
Bloodless techniques are best applied to elective surgical procedures in which
there is a predictable amount of blood loss.
Are there conditions that might be less amenable to bloodless techniques?
How about other factors, such as age and gender, that might make an individual
a less promising candidate for bloodless surgery?
Patients who are suffering from severe anemia, who are experiencing an active
hemorrhage, who are known to have disorders that interfere with blood clotting,
who have suffered trauma, or who require a liver transplant are sometimes more
difficult to manage, unless they are treated by a team that is very experienced
in transfusion-free medicine.
Would you expect more complications in patients undergoing bloodless procedures?
Yes, although some of these complications are dependent on whether the patient
delays in coming to the hospital and initiating treatment, and whether complications
of anemia, bleeding, and shock have already set in. Furthermore, the complication
rate is dependent upon the specific diagnosis, patient's age, and the presence
of other complicating illnesses, such as heart disease.
Depending upon the specific type of therapy or procedures employed, there
may be increased risks. For example, acute normovolemic hemodilution, a procedure
done to expand the liquid portion of the blood volume, may not be safely done
in severely anemic patients, or in patients who have severe heart disease.
This procedure is sometimes performed prior to surgery, so that when bleeding
occurs, a smaller number of red blood cells are lost, proportionately, when
compared with bleeding without hemodilution.
Iron is often given to patients
with iron deficiency in order to stimulate blood production. Treating patients
with intravenous iron, however, may result in severe allergic reactions. Some
patients are given hematopoietic growth factors, such as recombinant human
erythropoietin, a natural hormone produced by the body to stimulate red blood
cell growth. These medications may not be appropriate for all patients. Using
some pharmacologic hemostatic agents may have side effects; aprotinin is associated
with allergic reactions, and aminocaproic acid may cause blood clots or a condition
called disseminated intravascular coagulation.
Should a patient go anywhere in particular to seek bloodless treatment? What
should a patient look for in a bloodless surgery center? In a surgeon?
It is important that patients who wish to receive bloodless care try to seek
treatment in an institution with an organized bloodless medicine program. It
is preferable that the institution have practice guidelines in place, and that
the medical care team be specifically trained and experienced in bloodless
medicine. Surgeons, anesthesiologists, hematologists, and nurses are all integral
parts of a successful bloodless medicine program.
Dr. Thomas Kickler serves on the editorial board of Transfusion and The
Journal of Transfusion Alternatives. He is board-certified in three specialties:
internal medicine, and hematology. Dr. Kickler is professor of medicine, oncology,
and pathology at the Johns Hopkins University School of Medicine.
Review Date: 5/10/2007
Reviewed By: Corey Cutler, M.D., M.P.H., F.R.C.P.C, Department of Medical Oncology,
Dana-Farber Cancer Institute; Instructor in Medicine, Harvard Medical School,
Boston, MA. Review provided by VeriMed Healthcare Network.
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