Bloodless Surgery for the Elderly








      Is Bloodless Surgery an Option for the Elderly?

      “The elderly utilize a disproportionate quantity of blood resources.”  -The Anemia Action Counsel and The American Society for Clinical Pathology

      “Anemia is not normal in the elderly and when identified before surgery requires thorough evaluation.”

      The elderly are especially at risk
      The elderly are given more blood transfusions than any other segment of the population. When admitted to intensive care they are more at risk of receiving a blood transfusion than other patients.

      Bloodless Surgery is regularly performed on the elderly with outstanding results. People in their sixties, seventies and eighties respond successfully to Bloodless Surgery, they are discharged from hospitals more quickly and end up in Intensive Care Units less often.

      Iris Carr - an 89 year old Bloodless Patient
      "Over the last five years, surgeons have replaced Iris Carr's knees, repaired a hip, and removed a gall bladder. They have opened her chest to slice away a tumor from her heart. She did not develop any of the infections that can result from receiving someone else's blood: "I'm glad I went through with it."" 
      -Iris Carr, Multiple  Bloodless Surgery Patient, age 89

      Imagine if Iris had received blood transfusions. They would stress her immune system and increase her chances of post surgical mortality. She would have worried needlessly about the side effects of a blood transfusion – worries that no one needs, much less the elderly. She would have increased her chances of ending up in a nursing home or the ICU for a prolonged stay. Iris avoided all this. Other aged patients besides Iris have the same stories to tell – surgery without blood transfusions.

      Bloodless Surgery for the ElderlySuccessful surgeries on the more vulnerable
      Bloodless Surgery is successfully performed on elderly patients for a broad variety of illnesses. Since the elderly are more vulnerable they especially can benefit from Bloodless Surgery. Post surgical mortality rates for the elderly who receive blood transfusion are high. These early deaths are avoidable with Bloodless Surgery.

      Why more blood transfused in the elderly?
      Anemia is the most common reason for a patient being given a blood transfusion. The elderly are more at risk for diseases and conditions that cause anemia. However, anemia is not normal, even for an elderly patient; anemia is a symptom of an underlying cause that can be treated or cured.

      “Treatment of perioperative anemia has been shown to decrease the need for transfusion, and improve patient outcomes and quality of life.”  -National Anemia Action Council

      Aging naturally puts a person at risk for some of the underlying causes of anemia, but anemia should not be viewed as simply an affliction that can be ignored because the patient is old. As with any other patient, anemia should be treated prior to surgery. Unfortunately anemia is often not diagnosed in the elderly or is ignored.  “Elderly people with anemia [have] a 150% increase in hospitalization risk.”

      Bloodless Surgery option for the elderlyUnderlying causes
      As seen below in the sources from Listen To The Experts it appears that autoimmune hemolytic anemia (AHIA) is the number one underlying cause of anemia in elderly patients. (AHIA is an autoimmune disease in which antibodies attack and kill red blood cells.) Iron deficiency is another cause. Folate deficiency anemia and Vitamin B-12 deficiency anemia are much less common but still significant enough to identify and treat in an elderly patient. (These figures will likely be different in undeveloped countries where the elderly cannot afford vitamin supplements.) Over 800,000 elderly patients in the United States are said to be under the anemia radar – they have anemia but are undiagnosed.

      According to the chart below Anemia of Chronic Disease (ACD) is the number one type of anemia in the elderly. Various chronic illnesses can cause ACD and are lumped together under the umbrella term Anemia of Chronic Disease – it does not include AHIA from the previous paragraph.

      Different sources give different ratings for the various kinds of anemia. But the point is this, although the data may not always agree the data tells a story – anemia is common in geriatric patients and must be treated prior to surgery in order to avoid blood transfusion.    

      Wide ranging consequences
      The consequences of a blood transfusion in the elderly may be more acute and may put an aged patient in a nursing home for an unnecessary prolonged recovery. A cascade of events can be set in motion. Prolonged bed stays for the geriatric patient can create other medical problems. This domino effect is avoidable by implementing Bloodless Surgery for aged patients.

      Nursing homes are in short supply and putting elderly patients in them when it is avoidable is a tragedy. Burdening the national health care system with this problem is also misfortunate.

      Avoiding blood transfusion in the elderly
      “American Geriatrics Society spokesman Charles Cefalu, MD, MS, tells WebMD that the diagnosis of anemia among elderly patients has not been a priority in the past because there were no effective treatments for the condition. That changed, however, with the introduction of
      epoetin alfa, the first drug approved for the treatment of anemia.”  -WebMD

      The treatment for a geriatric patient is basically the same for any other patient – pre and post surgical administration of erythropoietin. It is safe and effective. Since anemia is the most common reason for giving a patient blood treating anemia is the most sensible course for avoiding a blood transfusion.

      Bloodless Surgery
      All of the techniques used by Bloodless Surgeons on other patients can be employed on the elderly. This reduces their time in the hospital since they recover more quickly.

      Following surgery the elderly patient often ends up in the ICU where he is more
      likely to receive additional blood transfusions. Bloodless Surgery reduces the need to put geriatric patients in ICU.

      Bloodless Surgery is a viable option for elderly patients regardless of their age. States with high populations of older citizens, such as Florida, may have Bloodless Hospitals with more experience in handling geriatric patients. But, generally, the first concern should be choosing a suitable Bloodless Surgery Program and the second concern should be geriatric care since the elderly Bloodless Patient will recover faster and have fewer complications following surgery.                                     
      Safe bloodless transfusion          A safe bloodless transfusion
      National concerns
      The proportion of the population of the elderly is expected to double in the next two decades. This growing demographic should be of great concern to the medical community and to government policy makers worldwide. The elderly use twice the amount of blood than do other age groups and yet they donate very little blood. In other words the numbers of consumers is doubling and the number of suppliers is dwindling. This lopsided ratio should send red flags to governments worldwide.

      Their solution has been to back blood donation programs such as World Blood Donor Day. These programs have a short sighted goal – 100% volunteer donation verses paid donation or replacement donation from family members. A country may have 100% volunteer donations now but what about twenty years in the future when even more surgeries will be performed on a burgeoning geriatric population and the proportion of donors is smaller?

      The answer is here now
      Bloodless Surgery has the answer now. Any surgeon can become a Bloodless Surgeon and any hospital can become a Bloodless Hospital. The costs of instituting a Bloodless Surgery Program are recuperated through the savings amassed.

      Bloodless Surgery sidesteps any future emerging pathogens. Experts generally agree that unknown pathogens are on the increase as the planet warms up, man invades more forests and huge migrations of people from poorer countries move into more developed countries.

      The elderly will simply be more vulnerable to these changes. But if they choose Bloodless Surgery they can avoid them completely.

      Listen to the experts
      “Over 3 million people in the United States aged 65 years and older are anemic.” 
      -American Society of Hematology

      “The prospect of a doubling in the number of elderly persons over the next 25 years indicates that it is a task that cannot be ignored or deferred.” 
      -Jerry L. Spivak, M.D., of The Johns Hopkins University School of Medicine

      “Anemia is not normal in the elderly and when identified before surgery requires thorough evaluation.”

      “Iron-deficiency anemia represents only 15-23% of cases of anemia among the elderly.”  -

      “Vitamin B-12 deficiency is a very uncommon cause of anemia in elderly persons. Folate deficiency is also uncommon, in part related to widespread vitamin supplementation.” (5 –10%) 
      -emedicine, -American Academy of Family Physicians

      “Autoimmune hemolytic anemia (AHIA) is the most common cause in elderly patients” 
      -Health and Age

      “Roughly 13% of people over the age of 70 are anemic. The hope is that by correcting the anemia we can prevent … keep older people out of nursing homes and hospitals.”  -WebMD

      “Elderly people with anemia [have] a 150% increase in hospitalization risk.”  -
      “Undiagnosed pernicious anemia is a common finding in the elderly, especially among black and white women. If these findings can be extrapolated, almost 800,000 elderly people in the United States have undiagnosed and untreated pernicious anemia.”  -
      Carmel R. Department of Medicine, University of Southern California (USC) School of Medicine, Los Angeles, USA

      “As of 2003, the elderly comprise about 13% of the American population, but use about 25% of transfused blood.” 
      -Encyclopedia of Surgery

      “Elderly patients and patients who stayed longer in intensive care were more likely than other patients to be given a transfusion.”  -
      BMJ 2002;325:735 (5 October, 2007)

      “The impact of red blood cell transfusion on 30-day and 90-day mortality of elderly patients was investigated in 8,787 consecutive hip fracture patients. [12] The greatest variability in transfusion practice was observed in the hemoglobin range of 8.0 – 10.0 g/dL. In this subgroup, 2,474 of 4,452 patients (56%) received a blood transfusion but had a higher 30-day mortality than patients with similar hemoglobin levels who did not receive a transfusion.”

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