Treatment without transfusions
Hospitals are catering to patients who hope to avoid blood transfusions for religious and other reasons with new 'bloodless' medicine programs.
FOR some Americans, most notably Jehovah's Witnesses, the issue of transfusions has always been clear-cut: Their religious beliefs prohibit the use of blood products under any circumstances -- even life-saving ones. Others would simply prefer to avoid transfusions for safety or personal reasons.
Now, a growing number of hospitals are catering to both types of patients.
In the last decade, hospitals across the country have opened "bloodless," or "transfusion-free," medicine programs. Currently, almost 125 hospitals have established programs; in 1994, only about 35 did, according to the Bloodless Medicine and Surgery Institute, a private educational organization for medical professionals interested in blood conservation.
The approach appeals to far more than Jehovah's Witnesses. "Many patients know that transfusions carry risks that they simply don't want to incur," says Dr. Leo Orr, co-director of the transfusion-free program at Good Samaritan Hospital in Los Angeles, one of the few hospitals in the area to offer this type of medicine. Orr estimates that almost 20% of the patients participating in his program are not Jehovah's Witnesses.
Bloodless programs employ a variety of techniques to minimize blood loss before, during and after treatments for many illnesses -- all in the hopes of avoiding the need for transfusions. Some are extraordinarily simple, such as collecting smaller-than-usual samples of blood for testing. Others involve the use of innovative medications, such as the hormone erythropoietin, which stimulates the bone marrow to produce red blood cells.
In the operating room, physicians use sophisticated surgical instruments such as a harmonic scalpel, which simultaneously cuts tissues and stops bleeding, and pay meticulous attention to surgical technique. They also use special surgical sealants and glues to control minor bleeding, and drugs such as tranexamic acid to help blood clot normally. Blood that is spilled during surgery often is collected, cleaned and returned to the patient using high-tech systems.
Dangers and fears
Advocates of bloodless medicine think that avoiding transfusions is worth all this effort, pointing to the dangers associated with transfusions. Minor allergic reactions are among the most common side effects. But, infrequently, incompatibilities between the donor and recipient trigger more serious reactions.
