The Growing Demand for Bloodless Medicine and Surgery - Blood and Jehovah's Witnesses

 For Bible-related reasons, Jehovah's Witnesses refuse blood transfusions.  But they do accept-and vigorously pursue-medical alternatives to blood.  "Jehovah's Witnesses actively seek the best in medical treatment," says Dr. Richard K. Spence, when directior of surgery at a New York hospital, "as a group, they are the best educated consumers the surgeon will ever encounter." 

Doctors have perfected  many bloodless surgery techniques on Jehovah's Witnesses.  Consider the experience of cardiovascular surgeon Dention Cooley. Over a period of 27 years, his team performed bloodless open-heart surgery on 663 of Jehovah's Witnesses.  The results clearly demonstrate that cardiac operations can be successfully performed without the use of  blood. 

True, many have criicized the Jehovah's Witnesses for their refusal of blood. But a guide published by the Association of Anaestheitist of Great Britain and Ireland calls the Witnesses'  position "a sign of respect for life."  In truth, the Witnesses' rigorous sand has been a major force behind safer medical treatment becoming available for all.  "Jehovah's Witnesses  in need of surgery have shown the way and exerted pressure for improvements in an important sector of the Norwegian health services," writes Professor Stein A. Evensen, of Norway's National Hospital. 

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A Growing Demand for Bloodless Medicie and Surgery - Conclusion of a Preferred Method

 Doctors have now successfully applied bloodless techniques during operations and emergency procedures that traditionally required transfusions.  "Major cardiac, vascular, gynaecological and obstetrical, orthopaedic, and urological surgery can be performed successfully without using blood or blood products," notes D.H. W. Wong, in the Canadian Journall of Anaesthesia.

One advantage of bloodless surgery is that it promotes better-quality care.  "The surgeon's skill is one of the greatest importance in the prevention of blood loss," says Dr. Benjamin J. Reichstein, a director of surgery in Cleveland, Ohio.  A South African legal journal says that in certain instances surgery without blood can be "quicker, cleaner, and less expensive."  It adds: "Certainly the aftercare treatment in many instances had proved cheaper  and less time consuming."  These are a just a few of the reasons why some 180 hospitals around the world now have programs specializing in bloodless medicine and surgery. 

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The Growing Demand for Bllodless Medicine and Surgery -A Preferred Method

Thankfully, there is an alternative-bloodless medicine and surgery.  Many patients view it not as a last resort but as a preferred treatment, and with good reason.  Stephen Geoffrey Pollard, a British consultant surgeon, notes the morbidity and morality rates among those who receive bloodless surgery are "at least as good as those patients who received blood, and in many cases they are spared the postoperative infections and complications often attributable to blood. "

How did Bloodless medical treatment develop?  In one sense the question is rather odd, since bloodless medicine actually predates the use of blood. Indeed, it was not until the early 20th century that transfusion technology had advanced to the point where it was routinely  used. Nevertheless, in recent decades some have  popularized the field of bloodless surgery.  For example, during the 1960's  noted surgeon Denton Cooley performed  some of the first open-heart operations without the use of blood.

With the rise of hepatitis among transfusion recipienrts during the 1970's, many doctors  began looking for alternatives to blood.  By the 1980's  a number of large medical teams were preforming bloodless surgery.  Then, when the AIDS epidemic broke out, these teams were repeatedly consulted by others who were eager to adapt the same techniquwes.  During the  1990's  many hospitals developed programs that offer bloodless options to their patients. 

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The Growing Demand for Bloodless Medicine and Surgery

 "All those dealing with blood and caring for surgical patients have to consider bloodless surgery." - Dr. Joachim  Boldt, professor of Anestesiology, Ludwigshafen, Germany.

THE tragedy of AIDS has compelled scientists and physicians to take additional steps to make the operating room a safer place.  Obviously, this has meant more strimget blood screening.  But experts  say that even these measures do not ensure zero-risk transfusions.  "Even as society expends great resources on making the blood supply safer than ever," says the magazine Transfusion, "we believe patients will still try to avoid allogeneic [donor] transfustions simply because the blood supply can never be completely safe."

Not surprisingly, many doctors are becoming wary of administering blood.  "Blood transfusions are basically no good, and we are very aggressive in avoiding  them for everybody," says DR. Alex Zapolanski, of San Francisco, California. 

The general publica too is becoming aware of the dangers of transfusions.  Indeed, a 1996 poll revealed that 89 percent of Canadians would prefer and alternate donated blood.  "Not all patients will refuse homologous transfusions as do Jehovah's Witnesses," states the Journal of Vascular Surgery.  "Nonetheless, the risks of disease  transmission and immuomodulation offer clear evidence that we must find alternatives  for all our patients.

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Blood Transfusions-A Long History of Controversy

 Blood Transfusions-No Medical Standard

Each year in the United States alone, more than 11,000,000 units of red cells are transfused into 3,000,000 patients.  In view of that large number, one would assume that there is a strict standard among physicians when it comes to administering blood. Yet, the New England Journal of Medicine noted that there is surprisingly little data "to guide decisions about transfusions."  Indeed, there is a wide variaion in practice, not only regardig precisely what is transfused and how much but also regarding whether a transfusion is adminstered at all.  "Transfusion depends of the doctor, not on the patient," says the medical journal Acta Anaesthesiologica Beligca.  Considering the above, it is hardly surprising that a study published in the New England Journal of Medicine found that "an estimated 66 percent of transfusions are administered inappropriately." 

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Blood Transfusions-A Long History of Controversy

 Another Scandar: HIV-Contaminated Blood

In the 1980's, it was found that blood can be contaminated with HIV, the virus that leads to AIDS. At first, blood bankers were loathe to consider that their supply might by tainted.  Many of them initially greeted the HIV threat with skepticism. According to Dr. Bruce Evatt, "It was as though someone had wandered in from the desert and said, 'I've seen an extraterrestrial.' They listened, but they just didn't believe it." 

Nevertheless, country after country has seen scandals break out exposing HIV-contaminated blood. It is established that in France, between 6,000 and 8,000  people were infected with HIV through transfusions that were administered between1982 and 1985.  Blood transfusions are held responsible for 10 percent of HIV infections throughout Africa and for 40 percent of the AIDS cases in Pakistan.  Today, because of improved screening, HIV transmission through blood tranfusions is rare in developed nations.  However, such transmissions continues to be a problem in developing nations that lack screening processes. 

Understandably, in recent years there has been an increased interest in bloodless medicine and surgery.  But is this a safe alternative?

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Blood Transfusions-A Long History of Controversy

 Blood-borne Diseases

 After World War II, great studies in medicine made possible some surgeries that were previously uninmaginable.  Consequently,  a global multimillion-dollar industry sprang up  to supply the blood for transfusion, which physicians began to consider standard operating procedure. 

Soon, however, concern over transfusion-related disease came to the fore.  During the Korean war, for example, nearly 22 percent of those who received plasma transfusions developed hepatitis-almost triple the rate during World War II. By the 1970's , the U.S. Center for Disease Control estimated the number of deathes from transfusion-related hepatitis at 3,500 a year.  Others put the figure ten times higher.

Thanks to better screening and more careful selection of donors, the number of cases of hepatitis-B contamination declined.  But then a new and sometimes fatal form of the virus -hepatis  C- too a heavy toll. It is estimated that four million Americans contracted the virus, several hundred of them through blood transfusions.  Granted, vigorious testing eventually reduced the prevalence of hepatis  C.  Still, some fear that new dangers will appear and will only be understood when it is too late. 

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Blood Transfusions-A Long History of Controversy

 Blood Transfusions and War

During  World War I, blood was literally trasfused into wounded soldiers.  Of course, blood clots quickly, and previously it would have been all but impossible to transport it to the battlefield.  But early in the 20th century, Dr. Richard Lwwisohn, of Mount Sinai Hospital in New York City, successfully experimented wiht an anticoagulant  called sodium citrate.  This exciting breakthrough was regarded by some doctors as a miracle.  "It was almost as if the sun had been made to stand still," wrote Dr. Bertram,  a distinquished phsician of his day.

World War II saw an increase in the demand for blood.  The public was bombarded woith posters bearing such slogans as "Give Blood Now," Your Blood Can Save Him." and "He Gave His Blood.  Will You Give Yours?"  The call for blood brought great response.  During World War II, some 13,000,000  units were donated in the United States.  It is estimated that in London more than 68,500 gallons [260,000 L] were collected and distributed.   Of course, blood transfusions carried a number of health risks, as soon became clear.

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Blood Transfusions-A Long History of Controversy

 Early Hazards

In the 19th century, blood transfusions made a comeback.  Leading the revival was an English obstetrician named James Blundell.  With his improved techniques and advanced instruments-and his insitence that only human blood should be used-Blundell brought blood transfusions back into the limelight.  

But in 1873, F.  Gersellious, a Polish doctor, slowed the transfusion revival with a frightening  discovery.  More  than  half  the transfusions performed had ended in death. Upon learning this, eminent physician began denouncing the procedure. The popularity of trasfusions once again waned. 

Then, in 1878, French physician Georgess Hayem perfected a saline solution, which he claimed could serve as a substitute for blood.  Unlike blood, the saline solution had no side effects, did clot, and was easy to transport.  Understandably, Hayem's solution came to be widely used.  Strangely, however, opinon soon favored blood again. Why?

In 1900, Autrian pathologist Karl Landesteiner discovered the existence of blood types, and  he found that one one of blood is not always compatible with another.  No wonder so many tramnsfusions in the past had ended in tragedy!  Now that could be changed, simply by making sure that the blood type of the donor was compatible with that of the recipient.  With this knowledge, physicians renewed their confidence in transfusions-just in time for World War I. 

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Blood Transfusions - A Long History of Controversy

 "If red blood cells were a new drug today, it would be very difficult to get it licensed." - Dr. Jeffrey Mc Cullough.

IN THE winter of 1667, a violent madman named Antoine Mauroy was brough to Jean-Baptiste Denis, eminent physician to King Louis XIV of France.  Denis had the ideal "cure" for Mauroy's mania-a transfusion of calf's blood, which he thought would have a calming effect on his patient.  But things did not go well for Mauroy.  Granted, after a second transfusion, his condition improved. But soon madness again seized the Frenchman, and before long he was dead. 

Even though it was later determined that Mauroy died from arsenic poisoning, Denis' experiments with animal blood provoked a heated controversy in France.  Finally, in 1670 the procedure was banned.  In time, the English Parliament and even the pope followed suit.  Blood transfusions fell into obscurity for the next 150 years. 

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