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Alternatives to blood transfusion

MagazineJune 1992 (Vol. 3 Issue 3)Alternatives to blood transfusion

The following are tried and tested alternatives to blood transfusion during various procedures

The following are tried and tested alternatives to blood transfusion during various procedures. If you or a loved one is due to undergo surgery or give birth, and you don't wish to have a blood transfusion, show these studies to your doctor and discuss the various alternatives. (You may also contact Jehovah's Witnesses for more medical citations and information about alternatives. In this country, they are at Watch Tower, The Ridgeway, London NW7 1RN Tel. 081 906 2211.) As usual, if your doctor pooh poohs your concern about blood transfusion, you might think about changing doctors. One important caveat, however: if you are undergoing surgery and wish not to be transfused make sure ahead of time that your doctor is familiar with these alternatives or refers you to someone who is. Simply refusing blood without resorting to alternatives is highly dangerous.

Anaesthesia: Numerous studies, many of Jehovah's Witness patients, show that patients can tolerate extremely low haemoglobin levels (as low as 1.7 gms/100 ml) during surgery and still survive.Emergencies such as haemorrhage and trauma: Numerous studies in the Journal of Trauma (January 1988) found that the patient's own contaminated shed blood (say, by exposure to intestinal contents) could be reused (or "autotransfused," as medicine terms it), through a cell washing recovery system. Circulating blood volume can be maintained by replacing fluid with colloids (starches and sugars) or crystalloids (gelatins or saline solutions). One study of some 10,000 surgery patients (Journal of Bloodless Medicine and Surgery, Spring 1986) concluded that adult patients can "undergo rapid loss of 1,000 to 2,000 ml of blood. They will not go into irreversible shock if haemodilution is adequate [ie, diluting blood by using artificial volume expanders]. This can be managed through DDAVP. . ." [ a drug called desmopressin, used to reduce urine production or to treat certain forms of diabetes, whose inadvertent side effect is to stop bleeding].

Premature infants: Numerous researchers have successfully helped preemies with erythropoietin (Ep), a synthetic version of a hormone produced by the kidneys, which causes the bone marrow to produce more red blood cells. (Pediatrics, May 1989 and Transfusion, Vol 29 No 1 1989). In one study (Journal of Pediatrics August 1982), premature infants with birth weights of less than 1 kg were able to somehow compensate for their size and maintain their haemoglobin concentrations at levels similar to those babies who were transfused.

Severe anaemia: Numerous studies have shown that haemoglobin levels as low as 2 to 2.5 gms/100 mls or even lower may not be life threatening; minimum haemoglobin levels tolerated by patients are highly individual and require individual testing. In these instances, Ep can also be given. Another safe possibility is to give replacement doses of intravenous iron dextran, a sugar iron solution, used often in the States, providing the blood with a booster to produce red blood cells (Archives of Surgery June 1985), or to ventilate the lungs, give high concentrations of pure oxygen and transfuse large volumes of gelatin solution (Anaesthesia January 1987). Concludes one study (Anaesthesia Vol 30, 1975): "Anaemia, even after the loss of over 80 per cent of the circulating red cell mass, recovers satisfactorily [with the infusion of isotonic non colloidal solutions.] During the following 90-180 days the plasma proteins, red cells and haemoglobin return to normal values without affecting the recovery of normal physical activity."

Blood disorders and excessive bleeding: Oxygen treatments and drugs like desmopressin will arrest haemorrhage (Hospital Practice, February 15, 1989).

Major Surgery: For any sort of major surgery, including coronary bypasses, congenital heart surgery or cancer, doctors have successfully employed autotransfusion techniques (Surgery of Gynecology and Obstetrics April 1989) or haemodilution. (Annals of Plastic Surgery May 1989, American Journal of Surgery July 1983, Journal of Pediatric Surgery August 1985, Thoracic & Cardiovascular Surgery June 1985). They've also used hypothermia (that is, lowered the patient's temperature to conserve blood loss, and used hypotensive anaesthesia (lowered blood pressure to conserve blood) with crystalloid replacement fluids (Irish Medical Journal November 1983). Catherizations of (placing tubes in) certain arteries can also control massive gastrointestinal haemorrhage. Indeed, one study believed that transfusion would drop by 50 per cent if doctors used crystalloid solutions for fluid replacement in place of the initial 1 or 2 units of blood routinely given for volume expansion. "We have now done approximately 6,000 open heart operations, [and] since we have not been using blood for the majority of patients, it is our impression that the patients do better," concluded one study (Journal of the American Medical Association 3 December 1973).

In obstetrics and gynaecology, patients have been successfully operated on with autotransfusion and hypotensive techniques, as have patients undergoing operations involving substantial blood loss suchas shoulder and hip replacement (American Journal of Bone and Joint Surgery March, 1986). Some doctors forced to conduct bloodless surgery on Witnesses have enjoyed such success in their patients that they've adopted the techniques even for those who would permit transfusion(New York State Journal of Medicine October 15, 1972).

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