Bloodless Surgery Becoming Gold Standard
If you have had major surgery in the past, no doubt your surgeon may have given you a blood transfusion due to blood loss during the surgical procedure. Most people consider that to be a necessary component of the process. That does not have to be the case anymore.
The tragedy of AIDS has forced physicians to look for ways to make surgery safer. More stringent blood screening has not been the total solution. These measures do not ensure there will be no risk if a blood transfusion is given to a patient. Many doctors are looking at other alternatives. "Blood transfusions are basically no good, and we are very aggressive in avoiding them for everybody," says Dr. Alex Zapolanski, of San Francisco, California. Errors and immunologic reactions with the use of blood have cost lives. Thousands of blood transfusions involved near-misses because of "collecting blood samples from the wrong patient, mislabeling samples and requesting blood for the wrong patient," says a 2001 Canadian study.
Patients receiving blood from another person face essentially the same risks as someone having an organ transplant. Immune responses tend to reject foreign tissue. In some cases, blood transfusions can actually prevent the activation of natural immune responses. This can leave the patient vulnerable to postoperative infections and to viruses that had previously been inactive.
Thankfully, there is an alternative-bloodless medicine and surgery. It is no longer considered a last resort, but a preferred treatment, the gold standard. Dr. Denton Cooley was one of the first doctors to perform open-heart operations without the use of blood as early as the 1960's. "Major cardiac, vascular, gynaecological and obstetrical, orthopaedic, and urological surgery can be performed successfully without using blood or blood products," notes D.H.W. Wong, in the Canadian Journal of Anaesthesia.
Some of the methods used include the following:
1. Fluids to maintain blood volume and preventing hypovolemic shock such as Ringer's lactate solution, dextran, hydroxyethyl starch, and others.
2. Drugs: Genetically engineered proteins can stimulate the production of red blood cells (erythropoietin), blood platelets (interleukin-11), and various white blood cells (GM-CSF, G-CSF).
3. Biological hemostats: Collagen and cellulose woven pads are used to stop bleeding by direct application. Fibrin glues and sealants can plug puncture wounds or cover large areas of bleeding tissue.
4. Blood salvage: Salvaging machines recover blood that is lost during surgery or trauma. The blood is cleansed and returned to the patient in a closed circuit.
5. Surgical tools: Some devices cut and seal blood vessels simultaneously. Other devices can seal bleeding on large areas of tissue. Laparoscopic and minimally invasive instruments allow surgeries to be performed without the blood loss associated with large incisions. Such devices include electrocautery, laser surgery, argon beam coagulator and gamma knife radiosurgery.
6. Surgical techniques: Thorough operative planning helps the surgical team to avoid complications. Prompt action to stop bleeding is essential. Dividing large surgeries into several smaller ones decrease total blood loss.
Previously a physician would administer blood if the hemoglobin level went below 10g. This no longer has valid scientific support. Prof. Earnest E. Moore states: "Studies have shown, physiologically, that the human being can tolerate much lower hemoglobin levels than previously assumed safe." Anemia can be compensated for by volume, because volume is the critical component for maintaining blood pressure. With low-cost blood expanders being available, current medical opinion increasingly abandons the arbitrary rule, proposed back in 1942, that a hemoglobin level of 10 was the transfusion trigger, or the lowest acceptable figure before administering a transfusion. Prof. Peter H. Earnshaw said: "I halved our transfusion rate by simply saying, 'could we lower our triggers from 10 to 8?' And just taking a little more control over the decision. That was very easy. That cost nothing."
One advantage of bloodless surgery is that it promotes better quality care. The surgeon's skill is of great importance. In certain instances surgery without blood can be quicker, cleaner and less expensive. REcovery times can be reduced significantly. The aftercare is also cheaper and less time-consuming.
On the basis of experience, many physicians conclude that, overall, transfusion-alternative health care is cost-effective. The most effective alternatives are generally the cheapest. Blood is a costly product. It takes more dedication than technical means. Similar results can be achieved without the use of costly machinery.
Time magazine stated, "there is a 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."
There is a benefit beyond saving money and meeting patient's physical needs. There is an ethical benefit. This care honors the patient's freedom of choice to accept or reject a certain treatment. There is an ethical duty of the physician not to do harm, to seek the best possible outcome for one's patient, as well as respect the patient's own views and decisions. Doctors have both a legal and ethical obligation to respect the patient's choice.
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."
If you are considering surgery and do not wish to have a blood transfusion, you may want to do the following:
1. Talk to your doctor about nonblood alternatives before the need for treatment arises.
2. Put your wishes down in writing, especially if a legal document is available for such a purpose.
3. If your physician is not willing to treat you without blood, seek a physician who will comply with your wishes.
4. Since some alternatives to blood require time to be effective, do not postpone seeking treatment if you know that you need an operation.
As an informed patient, you have the right to have the best care and surgery without blood can be one of your best alternatives for a successful and speedy recovery.