One thing I and others have encountered is the argument "If he/she does not get a blood transfusion, he/she will have a heart attack. This is in a patient with a low Hgb of 6.4 (diulted from 9.4, positive for 8 liters of fluid for volume) Any suggestions?

When reviewing medical literature pertaining to the efficacy of blood transfusions, it is essentially nonexistent. There have been a couple of recent studies that suggest that individuals fair better when blood conservation methods are employed opposed to blood transfusions. The situation you described has not been studied except in very small limited expost-facto samples. Those of us who are involved with formalized blood conservation have seen repeatedly Jehovah's Witness patients with cardiac problems deal very well with moderately to severe anemic episodes.

I guess the bottom line in what you described is: Show me the data????

Al,
It is a possibility, but there are a lot of variables to consider. One of the things that has to be looked at is the "patient as a whole." Weight, height, age, duration of anemia, etc. . . . Patients have been treated with Hgb' s as low as 2 & 3 and had successful outcomes. Quick action and using all available permissible tools and protocols could turn the patient around. When you are told that a heart attack might occur you might want to say, "Blood is not an option acceptable to this patient, so let's get started on what we can do." Encourage physicians to treat patients proactively instead of with the fatalistic view that if blood can't be used, then nothing else will work. Please call a "Blood Conservation Program" in your area. Most of us have physicians readily available for consultation to other physicians. Then they can speak "colleague to colleague."

I agree with the above statements. I will just add that we are involved in influencing a change of practice concerning any treatment decision that effects blood use. Please realize that changing practice comes under the catagory of a life change for our physician friends. Our Doctors are VERY busy people. They make decisions that effect life. They depend on standards and protocols to facilitate their practice. We are asking two tough things 1) do not settle into your SOP (standard operating protocols) with our patients and instead think outside the box 2) create protocols for our patients that will eventually become the accepted standard of care. Why is this difficult for some? Doctors are scientists and as such depend on research and proof. Some have the explorer mentality but many do not and will yield only when presented with unassailable proof. Our job is to provide them with reasonable alternative treatment options that in their opinion will not unduly expose their patient to danger.

The rule - Physician's listen to other physician's. If you can't find a paper supporting an alternate approach to anemia in a patient with a history of cardiac problems then look for a physician who can speak from their case history.

Resources include
PubMed - http://www.ncbi.nlm.nih.gov/PubMed/
Centers of Exellence
he Kay Group at Good Samaritan in Los Angeles - http://www.kaymed.com/medterms_bohs.htm (Manuel Estioko or colleagues)
University of Pennsylvania Bloodless - http://www.pennhealth.com/health_inf...ess/index.html

To name a few

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email