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Bloodless Medicine: How Do They Do That?

You need a new knee, shoulder or hip, whether a result of an accident, a genetic condition or years of wear and tear, your God-given joint is on its way out and a shiny, new replacement is on its way in. You schedule surgery and head to the hospital a few days before for the required pre-admission testing, including an autologous blood donation, should you need to be transfused during surgery. All standard pre-surgical procedure. Or is it?

Patricia Ford, MD, hematologist/oncologist and director of the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital would say ‘no’. Dr. Ford is a pioneer in the study and practice of bloodless-- transfusion free-- medicine as well as proper blood management and use. Why not transfuse? “Avoiding transfusions reduces complications and recovery time for patients in general. It’s amazing how much blood is collected and wasted and given unnecessarily in this country,” Dr. Ford told the Philadelphia Inquirer in a recent front-page story.

Over 15 years ago, Dr. Ford began to look more closely at transfusion-free medicine to meet the needs of her patients who refused blood transfusions- many for religious reasons, some for infection prevention. She discovered that blood-building agents such as iron, vitamin B12 and growth factors could rapidly boost the supply of red blood cells before surgery to avoid the need for transfusion. Now, all surgeries, including knee and hip replacement surgeries, complex cardiac, urologic and gynecologic procedures and even stem cell transplants are performed bloodless, or transfusion-free at Pennsylvania Hospital. 

Yes, stem cell transplants-- a standard of care for many blood cancers, such as lymphoma or myeloma. The thought was-- and still is among many physicians-- that a procedure of this magnitude left the body so weak and depleted of both red blood cells and platelets that a transfusion was necessary for survival. “Every doctor said patients would die of profound anemia or bleeding,” Dr. Ford told the Inquirer. She has now performed 100 (101 as of this writing), more than anyone in the world. Over 15 years, she has patients who have been in remission for “five, seven, even 10 years”. “People think I’m doing something mystical or magical,” said Ford. “It’s not.”

As a founding member of the Society for the Advancement of Bloodless Medicine (SABM), Dr. Ford is committed to reducing blood use in the US, and promoting best blood management strategies to improve patient outcomes. While our blood is safer than ever, transfusions still pose the risk of bacterial contamination, lung injury, transfusion errors, and more.

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