Bloodless medicine” started as
an alternative designed to meet
the needs of patients who
opposed blood transfusions for religious
reasons. Now, the practice has gained popularity due to the reduced risk of infection,
better outcomes and lower treatment
costs.
Bloodless medicine refers to the use of
devices, techniques and careful preparation that enable patients to lose less blood
— especially during surgical procedures.
The result is that many patients are able to
undergo surgery without external blood
transfusions.
The statistical outcomes for patients who
have fewer transfusions during surgery are
better. Patients also are learning that risk
avoidance is a medical benefit resulting
from the bloodless techniques, regardless
of their religious beliefs.
“We started treating patients with bloodless techniques here in Orange County in
the early 1980s, so we have a great deal of
experience,” says Dr. Vinod Malhotra, medical director of the Bloodless Medicine and
Surgery Program at Chapman Medical
Center. “Because 60 percent of surgeries
are elective and preplanned, the benefits
achieved through elimination of blood
transfusions are obvious. Patients just
need to be educated and learn to ask for
them from their physicians.”
Smart Business spoke with Malhotra
about what patients should know about
bloodless medicine and its related benefits.
What are the advantages of bloodless medicine?
First of all, there is less risk of contracting
a blood-borne disease. While today we are
able to detect the presence of many viruses
such as HIV in transfused blood, there was
a time when we were not able to do so.
Unfortunately, many patients contracted
HIV and hepatitis C through blood transfusions. What we do know, is that by avoiding transfused blood altogether, patients
contract fewer diseases.
Also, an allergic reaction occurs in 4 to 10
percent of all patients who receive a transfusion. Studies have shown that patients
who receive banked blood experience
increased adverse outcomes and longer
hospital stays. Accordingly, the cost of
treatment goes up.
In addition, there is now growing evidence
of the clinical adverse effects of blood transfusions on a patient’s immune system.
Studies have also shown that exposure to
red blood cell transfusions increases the
risks of the recurrence of cancer and the
development of post-operative infection.
Is there a quality differential with transfused
blood?
Yes, there certainly can be. Blood actually ages and legally, it can still be transfused
up to 42 days after the date of donation.
When we examine red blood cells under an
electron scanning microscope, what we
observe is that after 20 days, the red blood
cells actually start to shrink so the blood
loses its vitality.
Unfortunately, sometimes due to shortages, not every patient requiring a transfusion receives freshly donated blood. Trauma
centers need and use the most blood, so
they have it on hand; consequently, they frequently transfuse some of the oldest blood
to, ironically, the sickest patients.
This is also the problem with patients attempting to donate and store their own
blood prior to surgery. Patients often may
need to donate several units, but it requires
about a month to donate that amount of
blood safely. By the time of the surgery
date, the blood has aged and become stale
when it is transfused.
What makes bloodless medicine surgical
techniques unique?
Prior to elective surgery, the surgeon
should work with the patient to build up his
or her red blood cell count. Patients should
avoid aspirin and other blood thinners to
help reduce bleeding during the procedure.
Surgeons can further minimize blood loss
by using alternative surgical techniques,
such as carefully avoiding bleeding during
surgery and using a laparoscopic approach.
Additionally, surgeons may use a
machine called a cell saver that actually
siphons away a patient’s blood that is lost
during the procedure, cleans it, separates
out the red blood cells and reinfuses the
cells into the patient. These machines are
available to hospitals, so patients should
ask their surgeon to make arrangements to
use the machine prior to surgery.
What differentiates one bloodless program
from another?
A team approach at the hospital and the
amount of experience of the surgical staff
with the bloodless techniques is a vital
component to outcomes, as is the willingness of the surgeon to use them.
Patients should not only ask about the
experience of the medical team and their
outcomes but make certain that the surgeon understands the philosophy and the
patient’s wishes.
More than 89 percent of patients say they
prefer not to have a transfusion during surgery. Considering the risk reduction, bloodless medicine just makes sense.
DR. VINOD MALHOTRA is medical director of the Bloodless
Medicine and Surgery Program at Chapman Medical Center.
Reach him at (800) 970-9470. For more information visit
www.chapmanmedicalcenter.com/Bloodless.