Bloodless Medicine and Surgery: Treating Patients without Transfusions
Is it possible to perform medical and surgical procedures without transfusion or without using blood products such as whole blood, red cells, white cells, platelets or plasma? Bloodless medicine and surgery—BMS—is a set of strategies and policies that does just that.
As a matter of personal preference or religious beliefs, some patients will not accept a transfusion of blood or blood products. And, in other scenarios, conserving blood and minimizing blood loss during surgery have resulted in safer procedures and faster recoveries. In all these instances, MedStar Washington Hospital Center delivers cutting-edge expertise and the highest level of care to its patients by practicing bloodless medicine.
Our BMS program was established over a decade ago, and our leadership and medical staff have embraced the concept. We’ve adopted new techniques, developed solid policies, and leveraged technology to give our patients safe, effective and clinically sound options for blood products. And our program serves as a model for other healthcare organizations throughout the country.
Transfusion, of course, will always play an important role in healthcare—especially in emergencies and for those living with blood disorders. But substantial data now provides evidence that some transfusions are not only avoidable but could adversely affect patient outcomes.
Decades ago, the idea that major surgery could be performed without delivering blood or blood products to the patient would have been widely met with skepticism. Stored blood was administered in a wide range of situations, often without question. It was simply the routine and, as such, didn’t receive much scientific scrutiny.
But, thanks to some committed, courageous medical pioneers and religious leaders, we can make a very profound statement today:
Virtually no procedure demands the use of blood products, no matter what area of the body is being treated—even organ transplants.
It simply takes good planning.
In previous times, the idea that major surgery could be performed without the use of stored blood was met with skepticism. But times have changed. Antoine Williams, RN, explains bloodless medicine. @MedStarWHC via https://bit.ly/38DUBIp.
A Matter of Faith
Certain religious faiths take the Bible’s counsel against use or consumption of blood very seriously. This can be a quandary for patients who want to practice their faith without restriction—yet still receive the best possible surgical care.
The challenge was first recognized when the medical community adopted blood transfusion on a wide scale after it saved lives on the World War II battlefield. But real advances toward bloodless medicine began as surgeons interacted with members of the Jehovah’s Witnesses faith in particular.
Jehovah’s Witnesses have traditionally embraced modern medicine and medical intervention; however, their personal understanding of the Bible does not allow them to accept blood—whether donated or their own—in the course of medical care. In the 1960s, pioneering Texas surgeon Dr. Denton Cooley began performing bloodless open-heart surgeries for the Jehovah’s Witness community. He performed hundreds of such procedures, documenting and publishing results.
Over time, improved approaches and new technologies evolved, and hospitals all over the world began to adopt methods to serve patients who prefer bloodless procedures.
Studied for six decades now, bloodless medicine has proven both safe and clinically effective. A few facts:
- Bloodless procedures have a lower mortality rate than those using blood products.
- Patients undergoing bloodless procedures spend less time in the hospital.
- They also experience fewer surgical-site infections.
Overall, these procedures result in better outcomes and lower costs for both patients and the healthcare delivery system.
My father has a favorite saying: “Evolution is better than revolution.” I think of him a lot when discussing BMS. The culture change that it requires can happen very slowly, especially within large organizations. But over time, we’ve seen the dramatic shift as healthcare professionals gain a greater understanding of its benefits.
Essentially a Transplant
Today, we recognize that blood products are tissue, composed of cells and other human biological components. Giving a patient products derived from another person’s blood is, in essence, a transplant. In both training and practice, today’s medical community better appreciates the true implications: even when blood is a perfect match from a reliable and healthy donor, transplantation carries risk.
Medical professionals have always appreciated the gravity and complexity of organ transplantation—and it is typically the last resort, after other interventions fail. For example, we would never consider a kidney transplant as the first course of treatment for reduced kidney function.
In times past, blood did not receive the same deference. But today, the concept of blood as transplant has changed our thinking. Now, we’re more likely to ask: if we have good alternatives, why take the risk?
Safeguarding Blood Cells
The choice of BMS calls for open dialogue between provider and patient, who together review various options to minimize bleeding during treatment, as well as any potential risk.
During medical procedures, each component of blood plays a vital role, but the red blood cells are of greatest concern. Red blood cells bring oxygen from the lungs to all other parts of the body, and their loss can create problematic, temporary anemia and lack of oxygen.
At the Hospital Center, we have a variety of tools and techniques that help reduce the need for transfusion. For example, many of today’s surgical instruments and procedures can minimize blood loss.
Also, two key elements of BMS—cell salvage and hemodilution—aim to safeguard the patient’s blood cells.
- Cell salvage involves gentle suction of blood lost during a procedure. The salvaged material is stored, cleaned and transferred back to the patient as concentrated red cells.
- In hemodilution, a portion of the patient’s blood is collected and preserved before the procedure, and replaced with volume expansion fluid that matches the normal volume of the patient’s bloodstream. In this way, any blood lost during the procedure contains fewer red cells than normal, which means less overall cell loss.
These processes have largely replaced autologous donation—when the patient contributes his or her own blood prior to a procedure. Blood has a very short shelf life; even a few days’ storage can degrade it. So both cell salvage and hemodilution have the added advantage of administering fresher cells to the patient.
Another important element of BMS is anemia screening. Instead of managing a preexisting low blood count with transfused blood during the procedure, patients are carefully screened before the procedure, allowing enough time for treatment. The patient enters the operating room with the healthiest possible blood count, reducing the need for transfusion.
The Role of the Hospital Center
Our BMS program extends beyond the operating room. Behind every procedure and new development are the collaborative and educational resources of the International Training Center for Bloodless Medicine and Surgery, part of the MedStar Health Institute for Quality and Safety.
As we seek to help patients for whom blood conservation is an essential decision, it’s clear that medicine must balance science, art and judgment. The Training Center is both a think tank and a consulting service. It acts as a clearinghouse of research data. We provide classes, many of which grant continuing education credits. We run a hotline for medical professionals with the latest information on BMS.
Only about 90 BMS programs exist nationwide, and there is a great need for more. We help healthcare providers around the country to build and refine their own bloodless programs, putting MedStar Washington Hospital Center and our other hospitals in a leadership role to expand the practice of bloodless medicine and surgery.
I have seen friends and family members face challenges when working with providers who do not embrace BMS programs. I am proud to say that the Hospital Center offers patients the tools and knowledge they need to make an informed decision. And we’re empowered to respect that decision, thanks to bloodless medicine.
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