Bloodless Surgery

Its Benefits Gain Recognition

IN 1996 the Royal College of Surgeons of England published a booklet called the Code of Practice for the Surgical Management of Jehovah's Witnesses. In that booklet the surgeons note: "The dangers of blood transfusion make it desirable to consider alternative measures whenever possible."

AHA NEWS, published by the American Hospital Association, also reported on why the benefits of bloodless surgery have gained recognition. "What started as religious belief is evolving into medical preference and advanced technology," the weekly periodical observed. "Bloodless medicine and surgery, motivated in part by the doctrines of the Jehovah's Witnesses, is moving far beyond the needs of a spiritual society into operating rooms nationwide."

Why many doctors are promoting bloodless surgery was a subject featured in the 1997 fall edition of a supplement of Time magazine. "Fear of AIDS is only one reason," the article said. The article reported particularly on the work being done at Englewood Hospital's New Jersey Institute for the Advancement of Bloodless Medicine and Surgery, in Englewood, New Jersey.

Time observed: "The institute is the leader among more than 50 in the U.S. that now practice bloodless surgery. Without using any donor blood at all, they offer a wide range of surgical procedures that would ordinarily include transfusions, along with techniques that dramatically reduce, or virtually eliminate, blood loss."

Effective and Safe

The introduction of the Time article featured the experience of Henry Jackson, who suffered massive internal hemorrhaging that drained 90 percent of his blood and dropped his hemoglobin level to a life-threatening 1.7 grams per deciliter. Jackson was taken to the Englewood Hospital from another New Jersey hospital, which would not provide him treatment without using blood transfusions.

At the Englewood facility, under the care of Dr. Aryeh Shander, Jackson was given "high-potency formulations of iron supplements and vitamins, plus 'industrial doses' of a blood building drug, synthetic erythropoietin, that stimulates the bone marrow to produce red blood cells. Finally, intravenous fluids were administered to goad what little circulation he had left."

Time reported that a few days later, "the first hospital called to ask whether Jackson was dead. With undisguised satisfaction, Shander told them, 'He's not only not dead, but he's well and ready for discharge, and he'll soon be about his usual business.'"

In a television interview on November 28, 1997, Dr. Edwin Deitch, medical director for the bloodless program at University Hospital, Newark, New Jersey, explained how research into bloodless surgery developed: "Jehovah's Witnesses . . . went to a lot of effort to try to find people who would operate without blood. Some of the results of those studies found that they did better than was expected, [than] people who got blood."

Dr. Deitch added: "Blood can turn down the immune system and cause problems with postoperative infection; it can increase the risk of someone having recurring cancer, so blood, although it was good in certain circumstances, turns out to have a bad side." Of bloodless surgery, Dr. Deitch concluded: "It clearly improves patient outcome with less complications, and [it] costs less. And, therefore, it really is a winner in all circumstances."

Thus, as Time said, "more and more patients are clamoring for safer and more effective options than transfusions." The magazine also reported: "According to some estimates, 25% of U.S. transfusions are unnecessary. There are also indications that patients cannot tolerate levels of hemoglobin as high as previously thought and that young people especially have a built-in reserve of blood. . . . [Shander] is convinced that withholding blood is a viable and preferable choice for most patients."

Though contracting disease through blood transfusions is a major danger, there are others. "Banked blood, after it's cooled and stored, doesn't have the capability of fresh blood to transport oxygen," Dr. Shander explained. "We're just beginning to understand what it is we do when we give a transfusion."

"The Gold Standard"

"Finally," Time concluded, "there is the cost: at around $500 for each transfusion, plus administrative add-ons, the total bill comes to between $1 billion and $2 billion annually, more than enough incentive to consider alternatives." The staggering cost of blood transfusions now seems to be a major reason why bloodless surgery has become so popular.

Sharon Vernon, the director of the Center for Bloodless Medicine and Surgery at St. Vincent Charity Hospital, Cleveland, Ohio, said about the treatment of patients without using blood: "It's growing because physicians are recognizing that bloodless medicine is the gold standard in a cost-cutting environment. Our experience has been that even insurance companies that don't normally network with us, send people to us, because it saves them money."

Clearly, bloodless surgery is rapidly gaining recognition in the medical community, and that for a number of reasons.

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