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Behind the Scenes of Bloodless Medicine and Surgery

Annual spring symposium reenacts bloodless patient visit

In May, the Center for Bloodless Medicine & Surgery (CBMS) at Pennsylvania Hospital welcomed over 100 guests to their annual spring symposium for a behind the scenes look at what it’s like to be and treat a bloodless patient.  Yes, bloodless. The term may sound strange to some – maybe even like an oxymoron. How can the practice of medicine, and even more so surgery, be “bloodless?” What does it mean exactly, and why would it ever be practiced?  

As defined by NATA – the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis – the term bloodless medicine and surgery (BMS) is defined as the avoidance of allogeneic (from different individuals of the same species) blood transfusions. However, the actual practice of BMS entails much more than this.


Shown here is Byron Fairy, clinical technician and Perfusion Team leader, demonstrating an intraoperative cell salvage device at the CMBS symposium at Pennsylvania Hospital on May 17.

A “non-blood” or bloodless approach to medical and surgical treatment evolved from the need to treat patients who, for religious, personal, and ethical beliefs, seek medical care without the use of blood transfusions. For example, Jehovah's Witnesses firmly believe that blood “stands for life…has special significance…and should not be misused” nor should blood be removed from the body and stored – or taken in as it would via a transfusion.

“We continually strive to find the most effective way to inform and educate our patients and the community about bloodless medicine,” said Amy Brazina, manager of the CBMS, who organized and moderated the symposium, Behind the Scenes with the Center for Bloodless Medicine & Surgery. “This year, in addition to having a panel of bloodless experts from the Center available to speak and answer questions, we performed a skit where staff re-enacted the whole process of being admitted as a ‘bloodless’ patient coming in through the Center, enrolling into the program,  and into the hospital.”

The skit scenario detailed every step from when and why a patient should call the CMBS to admissions and all the way through to post-operative care. It was performed by a “patient” (a CBMS staff member), CBMS coordinator, secretary, and admissions representative. The ensemble acted out six different scenerios and during one, panelists Byron Fairy, clinical technician and Perfusion Team leader, and Eugene Lomas, Perioperative Nursing, gave a demonstration of an intraoperative cell salvage device. More commonly known as a “cell-saver,” the machine is used as a blood salvaging technique during surgery. A patient’s blood is suctioned, washed, and filtered so it can be given back to the patient. Since patients receive their own blood instead of a donor, there is no risk of disease transmission and since blood is re-circulated, there is no limit to the amount that can be given back to a patient. All members of the dedicated perfusion team at the CBMS at Pennsylvania Hospital each have at least ten years of experience in treating bloodless patients.

Symposium panelists included David Nazarian, MD, director of Hip Surgery at Pennsylvania Hospital, who has performed more bloodless joint replacements than anyone else in the world, and Jeremy Souder, MD, director of Palliative Care Services. Souder spurred a thought-provoking discussion about patient autonomy and end of life decisions.  “We work with whatever supports that people have to make certain that they are cared for in a way that makes sense to them and is in line with their beliefs and wishes,” said Souder.

Established in 1996, the CMBS is one of the oldest and largest centers in the country specializing in treating patients without using whole blood or blood products such as red cells, white cells, platelets, and plasma.

“We treat over 700 bloodless patients a year through out the center where we have the ability to perform common and advanced procedures without using blood or blood components,” said Patricia A. Ford, MD, founder and director of the CBMS at Pennsylvania Hospital, director of Peripheral Stem Cell Transplant Program, and clinical professor of Medicine.

For the past 18 years, Dr. Ford has been fine-tuning ways to best treat BMS patients, applying those techniques to a broader population, and teaching others to do this same. Why? “Research has shown that avoiding blood transfusions reduces patient complications and recovery time, and reduces health care costs,” said Dr. Ford. “There is a misconception in medicine – one that I may have even thought myself at one time – that a lot of patients just can’t survive without having a certain level of blood or receiving transfusions.  While that is true in some specific cases, it is simply not true for most. I’ve learned that we can effectively care for patients without the use of blood by applying easy medical strategies and blood conservation during surgery such as with the use of an intraoperative cell salvage device.”

Dr. Ford – who is also a founding member of the Society for the Advancement of Blood Management –performed the world's first no-transfusion stem cell transplant in a cancer patient over 17 years ago – something thought virtually impossible at the time and still considered too risky by most other BMS centers. Ford has since successfully treated over 120 stem cell transplant patients bloodlessly, more than anywhere else in the world. Yet the most progressive result of the efforts of Dr. Ford and the CBMS lies in its ability to change medical practice. While blood management and conservation strategies were originally developed for Jehovah’s Witnesses who reject transfusions because of their beliefs, they are now standard practice throughout Pennsylvania Hospital. 

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