What is a Bloodless Transfusion?
"Despite the prevalence of [blood] transfusion, there is scant evidence of its effectiveness." -Deborah Josefson Nebraska, British Medical Journal 2002;325:735 (5 October)
"Over 3000 articles are in the literature delineating the risks of blood transfusion." -Ann Thorac Surg 2002;74:986-987
What is a Bloodless Transfusion?
Some people equate the word 'transfusion' with a blood transfusion. This could be due to the fact that the thought of 'blood transfusion' itself has been impressed so deeply into our subconscious. The ads and pleas for blood donation have saturated western society for decades. For over 60 years the medical community has been taught to believe that blood transfusions are a life saver – that blood is the "gift of life."
Movies, television and news reports convey images of dramatic 'transfusions' that save lives. All this media saturation may have contributed to the idea in many people’s minds that a transfusion is a blood transfusion.
According to Dr. Irwin Gross, Director, EMMC Blood Conservation Program "[The] medical establishment [has] have been hard-wired to see transfusions only as a life-saving tool."
In a similar way Americans often ask for an Aspirin® and think that all pain killers that contain acetylsalicylic acid are Aspirin®. Aspirin® is in fact a trademarked name registered by Bayer Pharmaceutical and is not a generic term. The word Aspirin® is imbedded in people’s minds and many apply the term to any brand of acetylsalicylic acid, some even referring to other painkillers like ibuprofen as Aspirin®. The word transfusion is often used by the general public in the same way.
The point is: in medicine many products are transfused. Many patients who refuse blood transfusions have no objections to bloodless transfusions. They include the following:
Colloidal solutions – a group of intravenous fluids containing purified water, salts, and sugars. They may be given to replace the fluids, salts, and sugars that are lost during surgery or as volume expanders. Many who refuse a blood transfusion on grounds of religious conscience may accept colloidal transfusions.
Crystalloid solution – a group of intravenous fluids containing purified water, salts, and sugars. They may be given to replace the fluids, salts, and sugars that are lost during surgery or as volume expanders. Many who refuse a blood transfusion on grounds of religious conscience may accept crystalloid transfusions.
D5W (A water solution with 5% dextrose) - (basically - water and sugar)
Hetastarch – an intravenous fluid. The main components are distilled water and amylopectin (a natural polymer of glucose found in plant starch.)
Lactated Ringer's Solution / Ringer's Lactate – a volume expander that contains in decreasing amounts sodium ion, chloride ion, lactate, potassium ion and calcium ion.
Normal saline solution – basically sterile water and salt (sodium chloride) used as a volume expander.
Pentastarch – an intravenous fluid consisting of distilled water and amylopectin (a glucose found in plants) and used as a volume expander.
Saline / Saline solution – often used in Bloodless Medicine as a volume expander in cases of blood loss. It is a solution of sodium chloride (salt), sterile water and sometimes dextrose or glucose. It is generally administered to a patient as an intravenous (IV) infusion or through an IV drip.
Volume expanders can be used in conjunction with Acute Normovolemic Hemodilution:
Acute Normovolemic Hemodilution (ANH) – Acute Normovolemic Hemodilution is a preoperative hemodilution - preoperative (that is it is begun immediately before or after anesthesia is administered and prior to the actual surgical procedure) - hemodilution (dilution of the blood.) The preoperative hemodilution procedure is induced by the isovolemic exchange (an exchange of mass or fluids wherein volume is maintained) of whole blood with volume expanders, to preserve the patient's blood while maintaining normal blood volume in the patient's body. It can eliminate the need for homologous blood (blood from another person) and is a common procedure in Bloodless Surgery. It is also known as Isovolemic Hemodilution (IVHD or IHD) or Intraoperative Hemodilution.
Cell Saver® – "Haemonetics invented surgical blood salvage nearly thirty years ago and has been an innovator in the field ever since. The Cell Saver® autologous blood recovery systems are used in operating room procedures in which there is rapid bleeding or high-volume blood loss." -Haemonetics
Although recycling a patient’s blood is not a bloodless transfusion it is a type of transfusion where homologous blood is not transfused but rather the patient’s blood is transfused back into his own body. The procedure is accomplished by means of a cell salvage machine, the most common being the Cell Saver®.
The role of bloodless transfusion in Bloodless Medicine
These non-blood fluids are used to increase the volume of fluid in the circulatory system. When a patient bleeds excessively during surgery the volume of fluids in his circulatory system drops and the patient can slip into shock. Volume expanders increase the volume back to normal.
Bloodless transfusions are safe. They accomplish a vital task in restoring blood volume and avoiding shock. They also avoid the risks associated with blood transfusions. Bloodless transfusions are approved by the medical establishment worldwide, are not experimental or new. They have been in use for decades and are a mainstay of Bloodless Surgery.
Blood – an expensive volume expander
"New research from Duke University shows that donor blood looses nitric oxide within two or three hours after being drawn from the body. As the blood looses its nitric oxide, it looses its ability to transport oxygen, "therefore it doesn't do what it's supposed to do. At that point, it's just a volume expander, and we can give that in the form of fluids." -Mary Ann Rouch, Blood Conservation Program Coordinator, Presbyterian Hospital of Plano
Blood has been termed the most expensive volume expander in the world. It does not do what many have thought it should do – transport oxygen. Bloodless transfusions can do the only thing blood can do – act as a volume expander – but with the all the risk of a blood transfusion. Perhaps blood should be called the most dangerous volume expander used in medicine. Bloodless transfusions - they avoid the risk, but expand the volume.
Slow to change
The wheels of change are usually fixed to an oxcart not a Porsche. So it is in the world of medicine. Almost twenty years ago "A National Institutes of Health consensus development panel reviewed the use of blood products and introduced the idea of alternatives. Twelve years after the NIH report, transfusion behavior remains essentially unchanged." Aryeh Shander, Sherri Ozawa, Teekam D Ochani – AORN Journal, 01-JUL2001
Perhaps the only things that will bring about a switch to Bloodless Transfusions will be the economy, the demands of ordinary people who want Bloodless Treatment and possibly the insurance companies as they see the low costs of Bloodless transfusions compared tot the astronomical cost of blood transfusions. It is clear that the federal government is making no effort to bring about a change.
Don't wait on others to make your decision. Be informed. Act on your decision. Push the oxcart - don't wait for it to catch up to you.