Is There a Universal Definition of Bloodless Surgery?

"This is a blood avoidance program; it's not a blood elimination program. We will use blood to save somebody's life." -Jeffrey Lipton

Is there a universal definition of bloodless surgery?
The term Bloodless Surgery, as used on MyBlood, refers to surgery that purposely and carefully avoids the use of allogenic blood products. MyBlood uses the phrase as it is most commonly understood in the medical field. But the term Bloodless Surgery is not universally applied or understood.

This is why it is important for patients to be well informed. The term can have different meanings in different regions, in different hospitals in the same city and among doctors in the same hospital and is usually linked to a hospital’s Bloodless Surgery Program. Sometimes Bloodless Medicine and Surgery Programs are confused with Blood Conservation Programs which often aim to reduce and conserve the use of blood and not to eliminate the use of allogeneic blood.

Some hospitals have their own version of a Bloodless Medicine and Surgery Program that has the specific aim of reducing the use of blood products but not to eliminate them. In those hospitals it is likely that Bloodless Surgery has a different meaning.

It is important for all patients to educate themselves, to investigate and to thoroughly inquire of their doctors what program is being recommended. Is the hospital's aim to reduce the amount of blood transfused? Or is it solemnly oath bound to avoid surgery without blood at all cost?

Bloodless Surgery and Medicine Programs
As a minimum hospitals with excellent Bloodless Programs should have appropriate forms, and 'no blood signs' in patient rooms along with 'no blood bracelets' for ‘Bloodless Patients’ to distinguish them from other patients who are not concerned whether they receive blood or not. Most Bloodless Hospitals have trained liaisons who work with the Bloodless Patients. Often they are Bloodless Nurses with medical training or professionals from the field of Bloodless Medicine. And of course a Bloodless Hospital should have experienced Bloodless Surgeons. Bloodless Surgery requires a very skilled surgeon trained with specific tools, procedures and specialized equipment. Therefore, these hospitals should have adequately trained personal and ongoing training programs.

What constitutes a proper Bloodless Medicine and Surgery Training Program?
From a legal and licensing standpoint this question is difficult to answer. As it is, jurisdictions have different medical standards worldwide for common surgeries that permit the transfusion of blood. To date, however, there is no known specific licensing procedure nor are there any training standards for Bloodless Surgery established by any government, federal or local, anywhere in the world.

From a practical standpoint, a good Bloodless Medicine and Surgery Training Program should employ surgeons and technicians with years of experience and a good success ratio; a caring staff that aims to work with each individual Bloodless Patient and that respects the Bloodless Patient’s conscience and preferences; and an administrative staff that views Bloodless Medicine as a right, not as a means to make money.

Bloodless Surgeons are of course, licensed surgeons but they are not licensed as Bloodless Surgeons. Training of Bloodless Surgeons takes place in hospitals, seminars, and in some medical schools. Their skill level is higher than a conventional surgeon since the skill of Bloodless Surgery demands a higher level of accuracy.

Society for the Advancement of Bloodless Medicine
Many Bloodless Surgeons and other Bloodless Medical Professionals belong to the Society for the Advancement of Bloodless Medicine. Their website states:

"The membership of SABM is comprised of over 500 of the most recognized leaders in the field of blood management and conservation. This distinguished group includes: Anesthesiologists, Blood Management/Conservation Program Managers, Cardiologists, Critical Care Specialists, Health Care Administrators, Health-System Pharmacists, Hematologists, Hospitalists, Nephrologists, Nurses, Oncologists, Pathologists, Pediatricians, Perfusionists, Primary Care Physicians, Surgeons, and Transfusion Medicine Specialists."

SABM is the largest organization of its kind in the world. Many of the world's foremost experts in the field of Bloodless Medicine are members. However it does not have the authority to standardize the meaning of Bloodless Surgery or set standards for the definition of what constitutes a Bloodless Medicine and Surgery Program. In fact the organization is not dedicated to Total Bloodless Avoidance or true Bloodless Surgery. Rather its own stated mission is "the appropriate provision and use of blood, its components and derivatives, and strategies to reduce or avoid the need for a blood transfusion."

Though the organization is not dedicated to Total Blood Avoidance its members and its seminars have help to advance Bloodless Medicine worldwide since many if the strategies used to reduce blood transfusion can be used to eliminate blood transfusion.

A worldwide movement?
While it is true that, as Dr Vivek Jawali, Director of Wockhardt Hospitals says "Blood conservation is a global movement," the next step is to make ‘Bloodless Surgery and Medicine a global movement.’

Blood Conversation is a step in the right direction. In time, it will be seen that Total Blood Avoidance is the only 100% safe solution in any surgical situation. This statement is made based on the science. As one of the world’s foremost experts on blood stated "[repression of the immune system] may have long-lasting effects, even in a patient who has received a single unit of allogenic blood. Data supporting this association are even stronger than data linking cigarette smoking to lung cancer."  -Accessmylibrary - Shander, Ozawa and Teekam

Therefore, MyBlood follows the science and does not support halfway measures. Bloodless Surgery should be totally Bloodless not mean less blood.

Consistency
MyBlood would like to see a universal definition of Bloodless Surgery but does not see this occurring in the near future. Our survey of over 70 Bloodless Hospitals supports the conclusion that in the United States, which is the world leader in Bloodless Medicine and Surgery, the term Bloodless Surgery is understood by the vast majority to represent Total Blood Avoidance.

Bloodless Patients must educate themselves and determine what Bloodless Surgery means in the hospital that they are going to hand over their health to.

Listen to the Experts
"A lot of transfusions are just capricious."  -Robert L. Thurer, MD, American College of Chest Physicians in Orlando

"A blood transfusion is a liquid organ transplant."  -Dr. Spence, Chief of Surgery at St. Agnes HealthCare

"Patients enrolling in bloodless surgery programs [are] 'proactive' people who are aware that they have choices about health care and expect medical professionals to respect their decisions. This attitude is a considerable change from the 'doctor knows best' passive acceptance that characterized previous generations of patients."  -Encyclopedia of Surgery

"Bloodless surgery has slowly, but increasingly, crossed over to mainstream patients."  -Health Industry Today – Dec 1998 

"Since its establishment in 2001, the [blood management] program has …resulted in a …cost savings that exceed four million dollars per year."  -Strategic Blood Management

"Having a Center for Bloodless Medicine and Surgery [CBMS] specifically attracts a previously unseen population of patients to PAH. Therefore, all profit from the CBMS population, regardless of its magnitude can be considered as an incremental gain to the Hospital’s net margin. By creating and successfully running this program in today’s increasingly competitive healthcare environment, the CEO has strategically placed PAH in the forefront of modern health care."  -Blood (ASH Annual Meeting Abstracts) 2004 104: Abstract 5316

"Many institutions are not routinely offering all blood management choices to all patients."  -Sazama K,. The ethics of blood management. Vox Sang 2007;92:95-102

"Blood conservation programs offer a solution to the multiple problems that surround blood use."  -American Journal of Health-System Pharmacy Abstract Volume 62(18) September

"The cancer surgeon may need to become a bloodless surgeon."  -Dr. John S. Spratt, The American Journal of Surgery, issue of September 1986

"[Bloodless surgery] has now grown into a serious practice being embraced by internationally respected clinicians and institutions."  -V. Martin et al, (Abstract)Transfusion and Apheresis Science 2002 Aug;27(1):29-43

"Among the benefits [of Bloodless Surgery] are reductions in recovery time, hospital stay, cost and complications -- as well as an estimated $20,000 in savings per patient."  -Dr. Charles Bridges, Cardiologist, Pennsylvania Hospital 

"There may be a significant number of patients who delay or even decline surgery because of concerns about the blood supply. Bloodless surgery provides an alternative."  -University Times

"Bloodless surgery is also preferable to having patients transfused with their own blood."  -Dr. Charles Bridges, Cardiologist, Pennsylvania Hospital

"More than 75,000 doctors practice bloodless surgery in the U.S."  -Time- Oct 01,1997