Bloodless Medicine - Benefits and risks

The risks and benefits of bloodless methods -- compared to traditional medicine -- have not been well studied. The main benefit of bloodless medicine is that it allows people to avoid potential blood reactions and contaminants, and to follow certain religious beliefs. It also helps address blood supply issues. However, it is possible that bloodless medicine may provide a variety of other benefits, including fewer transfusion-associated complications, such as lung injuries. 

All of these possibilities are being studied, but the evidence is preliminary.

Keep in mind that ALL patients undergoing any type of surgery -- whether bloodless or conventional -- face certain risks. There may be additional risks specific to you and your personal medical condition and history. Your individual risk and benefit ratio should be reviewed specifically with your physicians as you consider the medical options available to you.

Bloodless medicine, however, has some unique considerations. 

When blood is lost -- but not replaced

In taking a bloodless approach, your health care team will strive to limit the possibility of heavy bleeding (hemorrhage). However, no surgical techniques or bloodless strategies can completely prevent the possibility of all bleeding. If an unforeseen circumstance results in major bleeding, and you have declined the use of blood donor products, you could experience serious blood loss that may need to be replaced to prevent organ injury or death. It is important that this unfortunate outcome be discussed in advance, so that you may guarantee that your wishes are followed. 

In the rare event that this occurs during elective surgery, the complications that you'll experience depend on the amount of blood lost, the speed with which the blood is lost, and your baseline level of health. Healthy adults can usually lose up to 20% of their normal blood volume without suffering permanent damage. If the blood loss occurs slowly over time, a loss greater than 20% of normal blood volume may be tolerated without permanent effects. 

However, severe blood loss can cause life-threatening complications such as low blood pressure, changes in the acidity of your blood, and decreased oxygen supply, resulting in damage to vital organs. 

Depending upon the specific type of therapy or procedures employed, there may be other increased risks. For example, using some 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. 

Discuss your options

If you are considering bloodless surgery, make sure that you understand the basic risks that accompany the particular procedure you'll be undergoing, discuss your unique personal risk factors with your health care team, and ask for help weighing the risks and benefits of using bloodless techniques.

Adapted from: Penn Medicine

Why people choose bloodless medicine

Traditionally, surgeons and other doctors have used blood transfusions (donated or banked blood, usually from another person) for a variety of medical situations. For example, people would have received blood transfusions if they had lost a great deal of blood during a surgical procedure, childbirth, or a serious injury. 

The rationale behind giving blood transfusions has always been to maintain a certain level of hemoglobin in your blood. Hemoglobin is a component of red blood cells, and it is responsible for carrying oxygen throughout your body. Low hemoglobin levels mean that less oxygen is being delivered to your tissues and organs. This has been thought to increase your risk of infection, slow your body's ability to heal, and cause tissue and organ damage

Proponents of bloodless medicine are re-examining the threshold level of hemoglobin necessary for good health and healing. They believe that patients can do well at lower hemoglobin levels than previously believed safe. And some proponents believe that the risks of a blood transfusion can, at times, outweigh the risks of low hemoglobin. 

Bloodless medicine may be chosen for a variety of reasons. Some of the most common are described below.

Religious convictions

If you belong to certain religious groups, most notably the Jehovah's Witnesses, your religious beliefs may state that you should not accept blood transfusions. Jehovah's Witnesses believe blood "stands for life... has special significance... and should not be misused." Their ethical principles state that blood should not be removed from the body and stored, nor taken in by another person. Therefore, Witnesses do not accept blood products containing plasma, red blood cells, white blood cells, and platelets -- which are sometimes referred to as major blood fractions. 

Clotting factors, albumin, growth factors, and immunoglobulins are sometimes referred to as minor blood fractions. If you are a Jehovah's Witness, whether or not you can accept treatment with a minor blood fraction may be considered an individual "matter of conscience." 

Concern about infections in the blood supply

In the early 1980s, a number of hemophiliacs contracted HIV through blood transfusions. Since then, public concern about infections transmitted through blood transfusions has increased. 

A variety of infectious agents have been discovered in the nation's blood supply, including:

• Hepatitis A, B, and C
• Malaria
• Syphilis
• Cytomegalovirus
• Herpesviruses
• Epstein-Barr virus
• Creutzfeldt-Jacob virus (which causes the human form of "mad cow" disease)
• West Nile virus

Potential donors can be screened, and donor blood tested and discarded, if found to contain some of these viruses.

Still, new viruses are regularly discovered in donor blood, requiring that new blood testing and screening procedures be put into place. 

Other complications from blood transfusions

While infections are certainly the most "in-the-news" complications, there are other medical risks of receiving blood transfusions. Everybody has a specific blood type, which refers to the biochemical markers located on their red blood cells. If you accidentally receive a transfusion of the wrong blood type, you can have a severe and even life-threatening reaction. Errors in blood typing do sometimes occur, prompting some people to prefer bloodless techniques over traditional transfusion medicine. 

Even if you get the right blood type from a donor, you could still undergo an allergic-type reaction to the transfusion because of other factors in the blood. 

A dwindling blood supply and rare blood types

As policies to cut down on infectious contamination of donor blood are instituted, more and more people are prohibited from donating. The donor pool continues to shrink, and the nation's blood supply has been steadily declining. Further, the cost of giving blood to patients has increased, due in part to the variety of tests to which donor blood must be subjected. If you have a rare blood type, it may be especially difficult to locate the kind of blood you need -- meaning that bloodless medical techniques may be crucial to your care.

 Adapted from: Penn Medicine

Bloodless Medicine

The term "bloodless medicine" refers to a variety of techniques that allow a patient to be treated without blood transfusions. This means that the patient does not receive any major blood products that have been stored or provided by donors. 

You may wish to request bloodless medicine techniques if you are scheduled to undergo a surgical procedure. In addition, some of these techniques can be applied to patients who have suffered traumatic injuries.

Bloodless techniques may be performed before, during, and after your surgery, and may include a combination of diet, medication, surgical techniques, and other strategies. Some of the common goals are to:

• Boost your red blood cell count prior to surgery
• Monitor and optimize oxygen delivery during surgery
• Avoid blood loss during surgery
• Collect and reuse your own blood during surgery

Bloodless medicine is growing

The practice of bloodless medicine is growing by leaps and bounds. In early 1990, you would have been able to choose from only a small number of medical centers providing bloodless health care. By 1996, you could have chosen from about 76 centers.

Today, more than 100 American medical centers are known for providing bloodless care, and even more centers are exploring the technologies and practices that will make such care a regular option for interested patients. Overall, health care practitioners are making efforts to avoid the use of blood products whenever possible, even in centers that do not specifically focus on bloodless medicine. 

The components of blood

 

To better understand the issues surrounding bloodless medicine, it's important to have a basic understanding of blood. In a given sample of your blood, more than half of the sample is made up of a watery substance called plasma, which contains proteins, immune cells, clotting factors, and various salts.

About half of the sample is made up of red blood cells, which contain oxygen-carrying hemoglobin. Less than 1% of the sample is made up of white blood cells (infection-fighting cells) and platelets (sticky little cell fragments that are involved in helping the blood clot).

Adapted from:  Penn Medicine