Bloodless Surgery

Abstract There have been many court cases that has made, parent who deny their child blood transfusion, to have to get one. Most time the courts will side with the parents, but if their decision not to is life threatening, the court side with the hospital. Most times it is for religious reasons that parent don’t want their child to have blood transfusion. There are many risks associated with blood transfusion, some parents don’t want to take that risk. Some of the diseases you can get are hepatitis B and hepatitis C. HIV and AIDS can also be contracted through blood transfusion. It can even lead to death of a recipient.

Is it ethical for parents to chose for their kids not to have blood transfusion. There is an alternative to blood transfusion. There are many tools and techniques to prevent the need for blood transfusion. Many doctors today are moving more towards bloodless surgery. The growth of bloodless surgery can be largely due to the number of Jehovah’s Witness patients. It is beneficial for both the patient and the hospital. More cost effective and faster recovery. I will talk about how preoperative planning is important for a successful bloodless surgery. I will touch on technique like cell savaging and Normothermia.

Also introduce you to a cool tool called Cyber-Knife. I will show how Jehovah’s Witnesses and their Hospital Liaison Committee help my family when it came to bloodless surgery. Blood transfusions have been known to have many dangers. In most cases the cons outweighs the pros, causing many people to consider alternative measures. Today one of the most innovative and effective alternatives is bloodless surgery. In the event that you are faced by such a challenging yet important decision such a surgery, allow me to enlighten you on some of the statistics, procedures and benefits of bloodless surgery to assist you in making an informed decision.

As we look at some of the dangers that are associated with blood transfusion alongside modern methods, equipment and benefits of bloodless surgery. We will see how these procedures have progressed over the years, and how the increase in use of bloodless surgery can be attributed to a small group of people known as Jehovah’s Witness. Witnesses as patients will not accept blood transfusion, under any circumstances. This has caused doctors to look for other solutions. The reasons why you should use bloodless surgery are the risk associated with blood transfusion.

Transfusions have been used for over fifty years in clinical medicine. Within those fifty years it has become apparent that the risk such as infectious viruses, bacterial infections and even death has been linked to blood transfusion. Infectious viruses include but are limited to blood borne pathogens like hepatitis B and C. The Blood bank reports “for screened units of blood in 2007, 1 in 137,000 had hepatitis B, fewer than 1 in 1,000,000 for hepatitis C” (Nagarsheth, N. P. , Sasan, F. 2009) Blood transfusions have been associated with higher incidence of bacterial infections.

“Bacterial infection was 2 percent non-transfusion patients, 15 percent for those with up to 2 units of blood red blood cells transfused, 22 percent with three to five units of blood, and 29 percent for patients transfused with 6 or more units of blood. ” (Nagarsheth, N. P. , Sasan, F. 2009) The more blood received in a transfusion, the more likely you are to get a postoperative infection. Many People today receive multiple transfusions. Transfusion in time develops allergenic immunization. This limits the supply of compatible blood. These numbers may seem like lottery chances, but why take the chance.

Ultimately there is death. Death is not a foreign outcome of blood transfusion. Transfusion related acute lung injury or TRALI, was first reported in the early 90’s. It’s a life threading reaction following a blood transfusion. TRALI is now known to cause many deaths each year. However, experts believe that the number of death is much higher than what is reported in relation to TRALI, because many doctors are unaware of the symptoms. The cause for such a reaction is conclusive. New scientist states “The blood that causes TRALI appears to come primarily from people who have multiple transfusions.

TRALI is the top reason for blood transfusion death in the world. Jehovah’s Witnesses have benefited greatly from their faithful course. Although their reason for not having blood transfusions are not because of the negative reasons that derive from it, but because of their devout belief in God and the Bible. They obey scripture such as Acts 15; 20 which states “abstain from blood” and Leviticus 7; 26 “you must not eat any blood. ” Jehovah’s Witnesses respect Gods authority and has taken their stand against blood transfusions, regardless of the outcome.

If you do not agree with such a point of view, let’s examine the benefits to bloodless surgery and its advancing technology. Over the years the tools and techniques of surgery without blood transfusion has improved greatly. One tool or technique used for surgeries with a lot of blood lost is called cell salvage. This involves recovering the blood lost by a patient, cleaning it, and putting it back into the patient. This is done non-stop during surgery. “Technological advances have increased system automation… offering higher processing speeds and better end product. ”(Lawrence Goodnough. 2003 Vol.

4) Cell salvaging is also cost effective for the hospital and the patient. If there is a surgery with lots of blood lost, it is cheaper to use cell salvage than the units of blood used in a transfusion. Also the recovery time is faster reducing the time and money a patient spends at a hospital. How can blood loss during surgery be lowered in order to lessen the chance for need of a blood transfusion? The key is preoperative planning for a successful bloodless surgery. The first thing to be considered is the amount of red blood cell (RBC) that will lost before a transfusion is needed. This is called the transfusion threshold.

Another thing that can be done before surgery is to “increase the patients RBC mass. ” (Watchtower Bible and Track Society, 2004) RBC mass can be increased by injection of iron into the patient. Also erythropoietin(EPO). EPO is a protein hormone produced by the kidneys. “This synthetic hormone acts like the natural erythropoietin found in our kidneys and stimulates the bone marrow to send new, fresh red cells into the bloodstream. ” (Watchtower. org)EPO is normally given 10 to 20 days before surgery. If you increase the RBC mass and lower the transfusion threshold, it allows for an even greater acceptable amount of blood loss.

Normothermia is a technique used to keep the patient’s body temperature during surgery. This helps keep the blood flowing properly. Managing the patient body temperature throughout the entire process reduces the surreal shock to the body which reduces the chances of incurring infection. The patient can be warmed by a thermal suit or a machine that infuses warm fluid into the body. The position can also help reduces blood loss during surgery. Local veins pressure changes depending on the field of relativity to the heart. Low pressure goes hand in hand with blood saved.

Stanford University Medical Center is a pioneer in the use of bloodless surgery in neurosurgery. “Without sawing into the skull or so much as cutting the scalp, they are curing patients whose brain and spine tumors were not long ago considered a death sentences. ” (Fillon, Mike 1997) These surgeries are possible with the use of Stanford University’s computer mediated stereotaxis radio surgery known as the Cyber-knife. The Cyber-Knife is basically a robotic x-ray gun that shots small amounts of radiation into the tumor in a lot of different directions.

This kills off the infected tissue without over exposing other parts of the body to radiation. Cyber-knife is a robotic arm that locks the radiation beam on to the tumor and constantly readjusts its aim in response to the patient’s natural small movement. To help doctors in providing treatment without blood transfusions, Jehovah’s Witnesses have developed a helpful liaison service. Presently, more than 1,400 Hospital Liaison Committees worldwide are equipped to provide doctors and researchers with medical literature from a data base of over 3,000 articles related to bloodless medicine and surgery.

Not only Jehovah’s Witnesses, but all patients in general today, are less likely to be given unnecessary transfusions because of the work of the Jehovah’s Witnesses’ Hospital Liaison Committees. In many surgeries which doctors felt that a transfusion was needed. The liaison committee has provided them with medical literature that shows how effective EPO can be. Some did not think that it would work fast enough to make up the amount of blood needed. A number of cases have shown how quickly EPO gets results.

“In one instance, on the very same day after EPO was administered, the count of new red cells was already four times normal! ”(Watchtower. org) My mother and father got to see how effective the liaison committee, and blood surgery first hand. When my brother was 16 years old, we found out that he had cancer in his knee. At that time there was no hospitals with a committee or doctor that would perform bloodless surgery on Staten Island. So the hospital liaison committee located Mount Sinai Hospital that had one doctor that did do bloodless surgery. My brother was put on EPO, and was the only patient that was.

For all of the doctors this was their first time use EPO, or even doing bloodless surgery. They were extremely surprised how much better he was doing than the other kid’s that were having blood transfusions. “It was really sad to see all those little kids and babies having blood pumped in to them. ” That is what my mother said when I was asking her about my brother surgery. She said “Junior what the only kid that was up walking around, all the other kids was in their beds look like they was about to die. ” Two things happened to my brother. First he lost all his hire because of chemotherapy.

He also lost his leg because that was the only way they could remove all the cancer. It is reasonable to conclude that although blood transfusion has been around for many years. With all its side effects such as, infectious viruses bacterial infections and even death. It is quickly becoming a thing of the past! With strong scriptural basis and its practical benefits, Jehovah’s Witnesses have been the main reason for the growth of bloodless surgery. Today hospitals across the world implanted bloodless programs to help meet the demand for this growing number.

Along with that, doctors have developed many techniques and tools in order to be successful in bloodless surgery. Techniques such as cell savaging and blood recovery and tools like the Cyber-knife. This have allowed for more cost effective surgeries, faster recovery, lower chance for infection and viruses. If ever surgery is something you have to undergo. I hope that I have persuaded you to make the right decision. References Cantrell, S. (2010). New normothermia measure heats up patient- temperature management. Healthcare Purchasing News, 34(3), 22-29.

Retrieved from EBSCOhost. Fillon, M. (1997). Bloodless surgery. Popular Mechanics, 174(1), 48. Retrieved from EBSCOhost. Goodnough, L. , & Shander, A. (2003). Evolution in alternatives to blood transfusion. Hematology Journal, 4(2), 87. Retrieved from EBSCOhost. Nagarsheth, N. P. , & Sasan, F. (2009). Bloodless Surgery in Gynecologic Oncology. Mount Sinai Journal of Medicine, 76(6), 589-597. doi:10. 1002/msj. 20146 Watch Tower Bible and track society of Pennsylvania. (2004) Transfusion Alternatives, Document Series. Watchtower. org

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