NoBlood

Abishai · #1 (**permalink**) 11-12-2007, 05:51 AM

New program offers "bloodless" surgery

By Marissa Vickers
Wednesday, November 7, 2007 8:49 AM CST

A great many people who have to undergo surgery are against accepting a blood transfusion -- some may note religious restrictions while others simply don't want to take the risks that are associated with receiving another donor's blood.

A one-of-a-kind program offered at Gateway Regional Medical Center accommodates the scores of people who elect not to receive a blood transfusion.

Todd Hofmeister, director of business and development and director of the program, Bloodless Surgery and Transfusion Options, said this practice is not a new concept."The first one was in 1987 at JFK Hospital in Chicago about 20 years ago. There's over 100 programs around the U.S. and worldwide probably a couple hundred," Hofmeister said.

He explained that back in the 1980s, when the world was facing the AIDS epidemic, physicians got together to try to come up with new ways to avoid using blood during surgeries. The bloodless surgery option was the result of their efforts.

"It's not what some people think, because there's no way you can do surgery without bleeding, but the patient will not receive blood from someone else -- it's blood transfusion free," Hofmeister said.

"Some people refuse blood transfusions for religious purposes, primarily Jehovah's Witnesses. (Others) don't want to be exposed to the risk of a blood transfusion, and there's numerous risks from AIDS to viruses to incompatibilities, bacterial -- so some people just say they don't want blood because they don't want that exposure," Hofmeister said.

He said tests are needed weeks prior to surgery in order to determine several factors such as an assessment of the patient's blood counts, the likelihood of his or her specific surgery causing additional bleeding, as well as if the patient may be anemic. Hofmeister said such an obstacle can be treated easily.

"Some are anemic so we'd need to get those (blood counts) up. We use a drug called Procrit and basically what that drug does is it stimulates the bone marrow to produce additional red blood cells. It just gets the bone marrow making more. Along with that we have to treat them with iron, vitamin C and folate -- kind of like a cocktail. We like to get that stuff started about four weeks before surgery," Hofmeister said.

If during surgery the patient starts to bleed, there are additional bloodless options that can be utilized.

"Meticulous hemostasis," Hofmeister explained, is a way of "stopping bleeding as it occurs -- using cautery to cauterize blood vessels. We don't want to be giving someone a blood transfusion if we don't have to. Also during surgery we can use cell saver, (which is) a way of collecting the blood that is bleeding. We wash and clean it to get rid of debris (and other contaminants) and remove the red blood cells. They're receiving back their own blood actually.

"It's a very common procedure for heart surgery or hip surgery. Now, if the patient is having some bleeding problems during surgery, there are drugs that can help with coagulation," Hofmeister said.

Another alternative to bloodless surgery is what Hofmeister calls blood management. He said it is virtually the same as the bloodless option, although participants in the blood management program will accept a blood transfusion only if it is a matter of life and death.

In his opinion, physicians tend to over utilize blood during surgery. Hofmeister said his short-term goal is to get doctors thinking out of the box and to avoid using blood as often as they do. His long-term goal is to raise awareness among all healthcare providers and hopefully have them implement the bloodless options.

Patients wishing to partake in either option at Gateway Regional Medical Center need to indicate their desires upon arrival. Hofmeister said paperwork is required and the medical staff will give the patient special wristbands, as well as place "no blood" stickers on his or her charts.

For more information, log onto www.sabm.org.

E-mail: mvickers@yourjournal.com

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Source: http://granitecitypress-record.stltoday.com/articles/2007/11/10/news/sj2tn20071107-1107edw_bloodweek.ii1.txt