NoBlood

SOUTH AFRICA

Alternatives to blood
May 4, 2005

Doctors at a Madrid Hospital have discovered a remarkable trend among members of the Jehovah's Witnesses, who refuse blood transfusions as part of their faith - last year all 52 of these patients underwent successful operations, from hip-replacement to tumour-removal, without a single transfusion.

The reason for the success, explain the doctors, is a "multi-modality blood conservation programme" at the Hospital Universitario de la Princesa.

The programme combines "different pharmacological and technical strategies" for preventing blood loss, wrote the hospital's Dr Marie Angeles Santos-Ampuero and four colleagues who presented their report at a medical conference in Prague.

Similar success stories were shared by doctors from Italy, Switzerland, Poland and other countries who attended the conference of the Network for Advancement of Transfusion Alternatives (Nata).

Nata members want to avoid or minimise the use of blood transfusions in medical procedures, not only for patients who refuse transfusions but for financial and safety reasons as well.

Experts suggest that non-transfusion techniques may be the wave of the future.

For example, James Ironside from the University of Edinburgh said blood donated for transfusions, as well as blood-derived drugs, may transmit variant Creutzfeldt-Jakob Disease (CJD), the deadly brain disorder linked to eating meat from BSE-infected cows. Ironside works with Britain's National Creutzfeldt-Jakob Disease
Surveillance Unit.

Dr Harvey Klein of the US National Institutes of Health reported that, based on past experience with the spread of the Aids and West Nile Viruses, donated blood could transmit infectious agents before medical experts had time to expand blood-screening programmes.

Klein said some blood used for transfusions had carried the West Nile Virus in the US between 1999 and 2004, when 87 people died, and blood now may be spreading a protozoal agent called babesia in Germany.

Cost was also a factor, they said. The Swedish Institute for Health Economics reported that a two-unit transfusion of donated blood costs a hospital hundreds of euros more than alternative techniques such as red cell salvage or autologous transfusion of a patient's own blood.

Similarly, researchers at Zaragoza University in Spain found that a blood-saving programme for elderly hip-fracture patients cut transfusion costs by 23%.

Examining costs from another angle were researchers from the World Health Organisation, who questioned whether developing-countries could afford the increasingly complex infection-screening programmes for donated blood that are common in wealthy countries.

But Czech doctors reported that, despite some success with drug treatment in lieu of transfusions, "the journey to routine use of ... a transfusion alternative is still long".

Other experts cited the shortcomings of so-called "volume replacement" fluids which can be used instead of blood plasma, and the need for more research into the use of special drugs aimed at stimulating a body's natural production of red blood cells.

But cheering on the doctors and their research were Jehovah's Witnesses, whose experts also attended the conference.

Mark Sanderson, a mediator between doctors and Witness patients in the US, cited the rising number of blood conservation programmes as evidence of a new attitude toward transfusions.

Sanderson said frequent shortages of donated blood, economic factors and doubts about the efficacy of red-cell transfusions had contributed to the opening of new programmes at scores of US medical centres.

He also noted that doctors who had opposed the Jehovah's Witnesses' position were changing as they examined the research that underscored the benefits of transfusion alternatives.

"Many doctors say we've come from two sides (of the blood issue)," Sanderson said, "but we've met at the same place." - Sapa-DPA.

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