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Bloodless Healthcare News You Can Use

Did You Know? White Blood Cell and Platelet Counts

In a normal adult body there are 4,000 to 10,000 (average 7,000) white blood cells (WBCs), or leukocytes, per microliter^[1] of blood. When the number of WBCs increases, this is a sign of an infection somewhere in the body.^[2] Antibiotics may be administered to help the immune system fight the infection.

In people with leukemia, the bone marrow produces abnormal WBCs. These abnormal cells are leukemia^[3] cells. They proliferate, and in time may crowd out normal WBCs, as well as red blood cells (RBCs) and platelets. As a consequence of this depletion of RBCs and platelets, the leukemia patient may become anemic and the risk of bleeding-particularly into the brain-may increase. Additionally, the standard treatment for leukemia is chemotherapy which exacerbates the anemia and bleeding risk because of its suppressive effect on the bone marrow, the body's blood cell factory. Doctors want to address these problems with blood transfusions.

Normal platelet counts range from 150,000 to 400,000 per cubic milliliter (150 - 400 x 10⁹/L), although many leukemia sufferers will fall well below 20 x 10⁹/L, once considered a trigger for transfusion. Doctors will not usually want to correct a low platelet count by blood transfusion unless the patient is bleeding or the count has fallen below 5 (x 10⁹/L).^[4] Anemia remains the biggest concern with leukemia, as with all cancers, and the patient who refuses blood transfusion presents considerable challenges for doctors. What alternatives may be available to these patients will be the subject of a future article in this series.

• The Blood Count

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Intraoperative blood salvage

What is a “cell saver”? How does it work? Is it new technology? If you have to have surgery involving anticipated blood loss, how can using this process benefit you? How safe is it? In short, you can actually have your own blood suctioned, cleaned, and reinfused into your body in a continuous circuit during your operation, which maximizes the amount of blood available to your tissues that might otherwise have been lost during the surgery.

In this article compiled by medical professionals, the entire process is described and diagrammed step by step, and other methods of intraoperative blood salvage are also discussed. If you are someone who prefers not to accept donor blood, or may have religious reasons not to have blood or blood components transfused during or after surgery, you will be interested in reading about this technique. The article also includes references to medical journals and other sources of information for those wishing to pursue the subject in further depth.

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Patients that refuse blood transfusions—FAQ's

In the complex world of medical care, there are people who, for various reasons, will not accept certain treatments or medications. Against the advice of their doctors and family, some choose to refuse or discontinue chemotherapy for cancer, even though they know the likelihood that their death may be imminent without the treatment.

Some concerned parents, whether due to religious or other objections, choose not to allow their children to receive immunizations others consider routine, even vital. Other people refuse to accept blood transfusions, even if such might prolong their life in an emergency. Many of the latter are Jehovah’s Witnesses, who assert a Bible-based objection to taking blood into their bodies.

What are some of the reasons that health care providers may encounter for Witnesses accepting or rejecting treatments or medications involving blood? Do all Witnesses make the same decisions? If not, why not? Physicians may experience understandable perplexity and frustration when, for example, one hemorrhaging Witness patient is willing to accept Factor VII, and one is not. For similar reasons, non-Witness family members and the general public may mistakenly perceive that Witnesses' choices are frivolous and even hypocritical...when in fact the choices they make are guided by individual conscience. Like any other human beings, the dictates of conscience on certain matters may differ between individuals who nonetheless hold earnestly to the same religious precepts.

With a view toward assisting physicians to better understand this issue, the NoBlood Team has started an ongoing Wiki project to discover and catalogue various reasons Witness patients might give for accepting or refusing various medications and treatments involving blood. This project is in the beginning stages, but is expected to evolve and develop with the help of health care professionals and others interested who may have a sincere interest in making positive contributions to this effort. We invite you to learn more here.

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Polyheme

There are now products on the medical market that are capable of carrying oxygen to the body’s tissues a lot like blood can. However, the most clinically successful products are made from human red blood cells. These are called Hemoglobin-Based Oxygen Carriers, or HBOCs. One of these has recently completed Phase III clinical trials amidst quite a bit of controversy over how the trials were conducted. It is called Polyheme®.

Would you like to learn how the product is made and how it is used? You can add to your knowledge of the field of blood replacement products by reading our article on Polyheme®.

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Article Summary: The approach to the patient who refuses blood transfusion

by Ms. Jan Grossberg, RN, BSN - NoBlood Editorial Team

This article was published in the September 2006 issue of the journal Transfusion.[1] Written by David M. Rogers and Kendall P. Crookston, from the Department of Pathology, University of New Mexico. It presents nine points comprising a “practical approach to caring for patients who refuse blood transfusion.” Neither author is affiliated with Jehovah’s Witnesses, but the article mentions Witnesses as a primary group that does refuse this type of treatment.

The authors recognize that blood is not always needed; that transfusions also have risks; and that physicians and other clinicians should always try to understand their patients and promote positive relationships with them. They further recommend tapping available resources such as ethics committees, consulting other professionals, or contacting the Hospital Liaison Committees of Jehovah’s Witnesses on matters regarding alternatives to blood transfusion.

The authors suggest limiting blood draws, seeking alternatives to the use of blood products, and exploring the various options for treatment, with patient and physician sharing the decision-making process equally. Patient confidentiality is stressed, as are careful record-keeping and the need to plan ahead for alternate treatment pathways in case the desired clinical course cannot be held to.

One feature of the article is a table listing specific treatments and products that may or may not be acceptable to Jehovah’s Witnesses, ranging from those that are unacceptable to those that may be accepted on the basis of individual conscience.This would be an excellent article for Witnesses to have on hand as a resource along with their Durable Power of Attorney, as it could prove beneficial to facilitate good communication and cooperation with health care providers in the event of medical need.

• Source

1. * Rogers, D.M. & Crookston, K.P. (2006), "The approach to the patient who refuses blood transfusion. Transfusion", Transfusion, vol. 46, no. 9, pp. 1471-77

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Spotlight: Alive and Well!

In September, NoBlood user martind posted his personal experience in the Spotlight Forum. I, for one, am going to print out and carry in my purse, in case I ever need emergency medical treatment. He suffered from multiple serious traumas: 27 broken bones, including all the bones in both legs, all the bones in both arms, several ribs, 4 vertebrae in his neck, a crushed ankle, knee and elbow, a punctured lung, and worst of all, the steering wheel crushed his head and he sustained a category 7 brain injury! With these horrendous injuries, he had lost all but about ½ pint of his blood, was unconscious and remained in a coma for 47 days. During that time his wife courageously bore the responsibility of upholding his religious stand on blood as one of Jehovah’s Witnesses. Many would consider it a miracle that he lived through it to tell us about it.

Importantly, martind’s situation involved many factors that, taken together, worked in a very powerful way to help preserve his life. The medical personnel used their skills in innovative and proactive ways while honoring his wishes not to receive blood transfusions; the Medical Liason Committee of Jehovah’s Witnesses came to the hospital and worked with the staff to explain his stand and offer assistance; an associate of NoBlood was contacted and worked with the hospital staff to provide medical information and resources that allowed his physicians and nurses to treat him successfully without blood. This was clearly a team effort with no valuable energy wasted in conflict over the patient’s refusal of a particular treatment. It appears that these medical providers gave their all to help a human being in need.

While recognizing the amazing value of respect and positive action on the part of martind’s healthcare team, I noted the heartrending post of philologus, which only serves to underscore the vital need for medical personnel to learn and apply true caring and respect for human dignity.

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Unanswered Questions, Can You Help?

by Larry Eitel, Executive Director

A hallmark of our community is the willingness to jump in to help others. Can you be of assistance with any of these:

Procrit to Aranesp posted September 8, 2006 by kscalici

Does anyone have a guideline or "practice" of switching bloodless patients from EPO to DARBO inpatient at a certain point? We continue to use EPO for bloodless inpatients who are anemic depending on how anemic and how fast we need to get them up we may start out daily for a couple days, give three times a week or once a week.

We have a long term inpatient who should have been switched to DARBO because she is now chronically anemic. Thought we would try to develop a standard like - give EPO until Hgb on the upswing, signs and symptoms improve, after 1 week of EPO etc.

Anyone know what I'm looking for?

Post Open-Heart Autotransfusion posted October 13, 2006 by Lori-carlson

Our Blood Management Program has been asked to develop a protocol and provide education to our CICU nurses on continuous post OH Autotransfusion. We use the Atrium Ocean Chest Drainage System. Our nurses understand that not all "no blood" patients require the continuous autotransfusion, but they want to be educated about the procedure for the few patients that do require it. I would appreciate any protocols you are willing to share, and also illustrations that might be useful for educational purposes.

Physician On-Boarding posted November 2, 2006 by MColumbus

I am on a hospital team that is putting together a manual for new physicians. I would appreciate any information that can be provided that shows 1) what bloodless information is provided to new physicians, and 2) what general information your hospital provides to new physicians.

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NoBlood Technical Team

The NoBlood Technical Team has created an area on the NoBlood Wiki for information detailing things we're working on with site development, as well as ongoing documentation of what's been done.

If you can help, even if you don't have any specific skills, check out the NoBlood Technical Team Wiki Page for more information as well as contact details.

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Call for Submissions

The first call for submissions went out with the last NoBlood Bulletin. Just to "prime the pump", so to speak, I am submitting a paper I wrote early this year while still a student nurse. It will be reviewed by editorial staff and, hopefully, considered worthy of publication here on NoBlood. I know there are a lot of very busy people out there who also have inspiring and intelligent things to say. I encourage all who have previously written a paper or article, or who wish to write something especially for publication here, to send us a copy of your work soon. If you don't currently have anything to submit, or don't have much time to write at the moment, why not encourage your peers who may be interested to consider joining our growing community, and to submit a piece for possible future publication? Thanks for helping to expand the scope and quality of NoBlood. We thank in advance those of you who readily respond to this call for submissions.

Articles should be submitted electronically as follows:

• as MS Word-compatible document
• include accurate citations for all works or websites referred to in the article
• all tables or graphics must be in JPEG or GIF file format
• include author’s full name, address, institution of affiliation, if any, and contact email
• send as attachment by email to editors@noblood.org

Submitted articles will be reviewed by the NoBlood Editorial Team, and authors will be notified of acceptance or suggestions for modification within two weeks of submission. (For help with correct style and citations, see The Ohio State University Libraries Citation Style Guides, or contact editors@noblood.org). Articles will be published on NoBlood in a separate publications section of the website. The exact date of publication will be determined by the NoBlood Editorial Team. The editors reserve the right to make changes in accepted manuscripts, for clarity and space considerations.

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"There's no free lunch."

“There’s no free lunch.” WHO SAID THAT??! Some guy that finally had to pay for a good pastrami sandwich even though he worked at the deli.

Well, NoBlood is at least as good as a pastrami sandwich, as we can all see by the quality of presentation and accessibility of information found here, not to mention the zeal and effort that goes into the posts, the newsletter, the teamwork. It’s delicious! But like a great pastrami sandwich, it doesn’t happen without great ingredients. To cook up what we see on NoBlood, someone has to buy or use their own hardware, software, phones and computers, , pay fees for access to online research libraries & journals, and donate time that might be reimbursed if given to a paying employer. Those who are spending their money on such resources really should be assisted in this, because what they are doing benefits all of us. So, look into your hearts, folks, and if you aren’t able to volunteer to use your other resources (like time, writing assistance, and so on) on behalf of NoBlood, consider making a donation of money to support the continued operation and improvement of services offered by NoBlood. It is the number one site for information and assistance with bloodless medical issues. Surely we all would like to keep it going and improving.

You get it. Whether you nibble or devour…There’s no free lunch!

Visit our Fundraising page and make a difference today.

Because Bloodless Healthcare International, Inc., the publisher of NoBlood, is a registered 501(c)3 organization, your donation is tax-deductible.

We at NoBlood appreciate your support!

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