From the Akron Beacon Journal (Ohio) website.
http://www.ohio.com/mld/ohio/news/br...ws/5244506.htm
Making every drop count - Bloodless surgeries stopgap attempts to ease blood shortage. Real cure? More blood donors Sunday Akron Beacon Journal: February 23, 2003; By Tracy Wheeler, Beacon Journal medical writer
The scene in the operating room of Cleveland's St. Vincent Charity Hospital looked much like any other. A heart monitor beeped rhythmically, while a surgeon and two assistants covered head to toe in blue scrubs leaned over the patient. Tubes, equipment and trays of gleaming silver tools crammed the already-cramped room. About 30 miles away, in Elyria, a nurse poked a needle into the arm of a woman at LifeShare. A clear plastic tube turned red with blood. It seemed to be a typical moment at a typical blood bank. But neither scene was exactly typical. Both of these everyday settings disguised techniques that could help to ease the nation's chronic blood shortage. It's a shortage that has left some parts of the country with less than one day's supply of blood. It's a shortage that has grown worse as concerns about exposure to mad cow disease and West Nile virus have eliminated people from donor lists. In response, blood banks across the country have focused on recruiting new donors, trying to lure people with creative who-can-donate-more-blood challenges between fraternities, businesses and even motorcycle groups. Still, despite such publicity measures, only 5 percent of eligible Americans give blood, according to the American Association of Blood Banks. That leaves technology as the next best hope. While techniques like those at St. Vincent hospital and LifeShare can't solve blood short = [100.0] ages, they can make them less daunting. ``We will never, ever not have a need for blood donation and blood supplies,'' said Debbie Tolich, director of St. Vincent's Regional Center for Blood Conservation. ``Ultimately, there will always be people sick enough to need blood transfusions and blood products. What blood conservation is all about is reducing the use of blood and utilizing blood more effectively for people who need it.
'' Bloodless surgery”
In the St. Vincent operating room, the only outward clue that the hip replacement was a ``bloodless surgery'' was a bag of blood hanging near the head of the table. It was attached to the patient's wrist using a needle with a V-shaped connection. The blood had been pumped from the patient through one branch of the V before the surgery started. After the operation was over, the blood would be returned to the patient through the other branch of the V. It was one continuous loop, from the patient's arm in one line, into the bag, and back to the arm in the other line. In essence, said Dr. John Bastulli, chief of anesthesiology at St. Vincent's, the blood never lost contact with the body. A patient undergoing bloodless surgery is treated with a drug, such as Procrit, which boosts production of red blood cells, in the three weeks prior to surgery. On the day of the surgery, one or two pints of blood are taken in the operating room before the surgery begins. The resulting loss of blood volume in the patient's body is replenished with saline. It's called hemodilution. And the result is that there's a supply of blood, rich in red blood cells, ready to go back into the patient after surgery. Plus, during the operation, the patient's blood is diluted, so fewer blood cells are lost from bleeding. Ultimately, it means the surgery takes place without using blood from an outside source. ``It becomes quite an attractive thing for people to hear they're almost guaranteed to not need blood once they've had a total joint replacement,’’ said Dr. Laurence Bilfield, chief of orthopedics at St. Vincent. ``It's not an absolute guarantee, but the chances are very good.''
Other benefits to surgery:
In just over a decade, the field of bloodless surgery has gone from obscure to vogue. In 1990, just three U.S. hospitals offered bloodless options. By 1996, the trend had spread to 76 hospitals nationwide. And today, the practice has expanded to about 150 hospitals. In Ohio, just six hospitals -- none in Akron or Canton -- are designated as blood conservation centers. A study conducted at St. Vincent between 1996 and 2000 shows why bloodless surgery is becoming popular. Dr. Joseph Sopko, director of the hospital's department of medicine,
compared two groups of 49 patients each. One group received blood transfusions during cardiovascular surgery; the other did not. The ``bloodless'' group had a lower rate of infection, though other factors, such as death rate and length of stays, were comparable. Other studies have found that bloodless surgeries result in fewer
infections than those surgeries that use autologous donations – blood donated by the patient weeks before the operation. Bloodless surgery also eliminates the possibility of ``other potentially devastating things, like hepatitis or HIV, though that's very rare,'' Bilfield said.
Ultimate conservation:
Tom Dupler, a 50-year-old Sandusky resident, was offered the option of bloodless surgery at University Hospitals of Cleveland when he underwent a heart transplant on Jan. 16. He said yes, but not out of concern over the safety of donated blood. ``It's nice to know you're not going to need blood from another source other than your own,'' Dupler said. ``I just prefer to do it that way. One of the reasons is the blood shortage. I'm O-negative, so I can give to anybody, but I can only take from O-negative.'' If fewer infections aren't enough to convince hospitals to move toward bloodless surgeries, money may be. The St. Vincent study found that the hospital would have saved $645,000 in blood costs if blood conservation techniques had been used in all surgeries from 1996 to 2000. Bilfield doesn't claim that St. Vincent is doing anything cutting-edge. The hospital has simply made the commitment to offer bloodless surgery in all its elective surgeries. About 98 percent of joint replacements at St. Vincent are now bloodless.``Everyone in the (operating room) is aware of the goal,'' he said.
More needs to be done:
The American Red Cross applauds the move toward more bloodless surgeries, as a way to reduce the demand on its blood supplies. But much more needs to be done to eliminate the blood shortage. ``Surgeries account for just a portion, about 25 percent, of the reasons why people need blood,'' said Karen Kelley, a spokesperson for the Red Cross' northern Ohio district. ``Even if 100 percent of surgeries were bloodless, there would still be a great need for blood.'' Trauma victims may need blood before surgery. Cancer patients rely on platelets to counter chemotherapy. Children with leukemia or sickle cell disease need regularly scheduled transfusions.``What's happening is that the need for blood is increasing every year,'' Kelley said. ``Our population is growing and our population is aging. It's an unfortunate fact of life -- the more a population ages, the more people tend to have conditions where they'll need blood. ``With the demand constantly increasing, today's decreased demand will be replaced by tomorrow's demand. It's an uphill battle.''
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