[i]There has been a lot of discussion about fractions. I highly suggest reading Dailey's Notes on Blood. Most fractions are heat-treated or washed with detergent. By the end of processing most do not contain RNA or DNA. Therefore, most fractions are pharmacuetical products. Cryo is one exception; it is a biologic fraction without processing. Therefore, there is a risk of disease.

__________________
Yvette Bunch

Larry, if the interest is fractions of primary components which (a) are similar in function to the whole component and (b) carry on a clear life sustaining role, platelet gel might also seem to qualify, in addition to HBOCs.

Considering many people have selected on their DPA the option of accepting *all* fractions derived from any primary blood component, if there's a new concern with HBOCs, platelet gel, etc, this might be a problem.

To accept or refuse blood fractions has ALWAYS been a matter of personal choice on the part of the patient. Nothing has changed. The fractions themselves have changed because science has made it possible to fractionate cellular products and repackage those fractions, suspend them in solution and give them the capability of being used by patients who refuse components of blood. (Simple, but factual explanation of HBOCs) This issue can be debated for hours, which is why we go back to the fact, 'to accept or refuse blood fractions has ALWAYS been a matter of personal choice on the part of the patient'.

As we pursue resources to educate ourselves and those requesting information from us, we should all remember to maintain an objective attitude during our search. Look for facts that can be repeated as fact with the appropriate reference for further examination. As is obvious in this thread, there is a plethora of information available - so as we all find it, let's be sure to share it.

Debbie A.

Understanding the Special Needs of Certain Groups and Cultures



I think we are all professionally concerned about how –certain patient groups and cultures - feel about products that are made from one of the primary components of blood. The Bloodless Program I manage has two enrollment categories. One is for patients who refuse Whole Blood or any of the four main components - Red Cells, White Cells, Platelets or Plasma. I must say that with the rare exception (perhaps two or three a year out of hundreds of patients) these patients are of one particular group. Therefore I feel I have an obligation to consider how these patients perceive existing and emerging therapies.

With that in mind, I will say that I utilize this groups local representatives when I seek clarification on how this group feels about any procedure or product. For example, an article was recently printed in a magazine produced by this group that considered the issue of blood. The article also covered the use of blood derived medical products such as albumin and immune globulins. As in the past, the magazine took the position that each individual must decide whether of not to accept these fractionated medicines. I spoke to the aforementioned leadership group to see whether anything had change.


A local member of this groups leadership told me that each person would need to consider the make up and therapeutic uses of available products, and decide what to do based on how he feels about the product in light of his personal beliefs. He stated that each person would need to be responsible to inquire as to the makeup of a medicine and make a decision based on his or her understanding of the issue of blood. He said that is what a conscience decision is all about. It’s personal. He cautioned me by stating, “You and your colleagues could describe the product and how it is used and leave it at that. Please do not answer questions like, “How many other members of my group have taken this� or “Do other members of my group take this?� He said he has heard of cases where Coordinators have told patients, “'Prominent members' of your group have taken this product�. He said this is a subtle, if unintentional, form of persuasion.

Anyway, I don't see any change from the way we have dealt with the issues of personal choice in the past.

Earlier in this thread I attached a PowerPoint file that dealt with percent of whole blood. However, this thread has changed....I am not certain that is the real issue. The aforementioned magazine said - "some products derived from one of the four primary components may be so similar to the function of the whole component and carry on such a life-sustaining role in the body�. I see a role and function in that statement, not a percentage. So I wonder why we should get into percentage issues here. Be that as it may, I would encourage any patient NOT to depend on healthcare professionals to help them make very personal and perhaps sacred decisions. When discussing these issues we as professionals should take the Dragnet position - "Just the facts" (about the product).

Conclusion - Since so many of our patients are made up of one particular group we have the need and responsibility to understand the issues. A professional discussion concerning this group seems appropriate with the caution provided by nanuke to "write what we are debating with caution", and I might add stick to the medical and clinical facts. This brings up another responsibility we all share when interacting with our patients on a daily basis - Make the choices clear, but do not lead the patient to a decision. Present the facts then stay out of the way!

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

I have been following this lively discussion with considerable interest, and would like to add my 50 cents’ worth.

While it is true that those with scruples (religious or otherwise) about the use of fractionated blood products will vary in their consciences, we must surely all agree that they need to be thoroughly informed before they can make any decisions in this area. In an ideal world, everyone filling out an advance health-care directive will take the time to investigate what sorts of products might be said to fall into the category of “minor blood fractions.� Then, should they ever be faced with making a decision about the use of a particular product will ask the crucial questions: What exactly is this product? How is it prepared? And what role does it perform in the body? Based on the answers to those questions they should have enough information to decide whether or not they personally could accept the administration of the product. Unfortunately, the reality is very different. Many have not investigated these questions—any many do not understand what products might fall into the category of “minor blood fractions.�

One of the aims of this forum is provided information to laypersons about these sorts of questions. So perhaps a list of basic products that are fractionated from primary components could be included here. I offer the following as a starting point:


It is true that this list will need to be updated as more and more products come on-stream, and it will also be necessary to provide a brief explanation of the role each of these products plays in the body. Then visitors to this forum who have religious concerns about these products can decide if a particular fraction may be viewed merely as having a healing or deficiency-correcting role in the body or whether it is a product that is “so similar to the function of the whole component and [carries] on such a life-sustaining role in the body that most Christians would find them objectionable.�

Attached Images

	Fractions.JPG (38.7 KB, 87 views)

I had included a flowchart (.gif) in the above posting but it doesn't seem to want to be displayed. Anyone offer any help?

I can view the image if I click on the thumbnail. Otherwise, the graphic would have to be uploaded to a server and then inserted/linked into the body of your post.

__________________
Larry Eitel
President & Webmaster

Click here and see who are advancing transfusion alternatives and blood management.

Can you spare a cup of coffee? Click here.
Thank you.

That is so true David and highlights just why Jan's report was valid:-
My experience has been that this is often the case and probably is due to the human trait of thinking "It won't happen to me!", hence failing to research properly. That having been said, the very fact that we are seeing this discussion amongst professionals indicates how difficult it must be for those who have religious convictions, or otherwise, regarding blood to come to an informed decision.

By the way group hug anyone?

David,

You could copy it to a Power Power slide and up load it that way.

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

Thanks for that suggestion Jan, I will consider doing that. My problem is that I can't see the thumbnail. Perhaps it's something to do with my browser settings?