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Did You Know? The Scope of Blood Transfusions

Ongoing blood shortages have been common place with continuing requests for blood donations from Blood Centers. This worry over blood availability, critical blood shortages, concern for safety, and rising costs have lead members in the healthcare industry to rethink its once more liberal use of blood to one of conservation. The statistical data regarding transfusions is quite impressive.

Each year in the United States, approximately 14 million units of blood are donated by 8 million volunteers. This, in turn, is transfused into approximately 4 million patients. For safety measures and to improve the quality of the United States blood supply, the pool of eligible blood donors has been decreased considerably. In addition, less then 5% of the eligible population donates blood. Globally, 17% of the populations in developed countries benefit from approximately 60% of the 75 million units donated annually.

In the US, blood products are needed every three seconds, breaking down to an average of 34,000-40,000 units each day. One person in 20 will require a blood transfusion sometime in their lifetime. People older than 65 use 43% of all blood donated, leading to an increased need for blood as the population base ages. One out of every 10 people entering a hospital requires blood. So why is this blood transfused? Consider the following:

1. Automobile Accident: 50 units of blood
2. Heart Surgery: 6 units of blood; 6 units of platelets
3. Organ Transplant: 40 units of blood; 30 units of platelets; 20 bags of cryoprecipitate; 25 units of fresh frozen plasma
4. Bone Marrow Transplant: 120 units of platelets; 20 units of blood
5. Burn: 20 units of platelets

* bloodtransfusion.com/stats.asp retrieved Nov 1, 2006

One unit of blood is equivalent to approximately one pint. The average adult has approximately 10-12 pints of blood within his circulatory system. Blood is composed of water, plasma, cellular components (red blood cells, white blood cells, and platelets), nutrients, proteins minerals and hormones. Blood may be transfused as "whole blood", or may be broken down into its individual components (plasma, red blood cells, platelets, cryoprecipitate) and transfused into several individuals. Blood may further be broken into blood fractions including but not limited to interferons, interleukins, albumin, and clotting factors.

In recent years, the cost of blood has increased by as much as 35%. Depending on the region, a unit may average $215. With further processing and additional screening costs, one unit of whole blood can cost as much as $485. As reported by St. Vincent Charity Hospital, many insurance companies do not cover the first two or three units needed in a medical procedure; hence the cost is transferred to the patient.

The decision to transfuse blood over the years has been predominantly left up to the discretion of the physician who is treating the patient, but physicians' transfusion practices can vary widely depending on their level of knowledge and interest (many physicians receive little academic training in blood component therapy), area of specialty (e.g., a hematologist vs. other specialist), and, possibly, the setting in which they practice. In addition, no clear-cut guidelines exist as to when blood transfusions should be considered. Physicians are, however, recognizing the need for more conservative transfusion practices and in many cases, based on prudent medical practices or patient decision, avoiding blood exposure all together.

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Prepare Now For a Possible Medical Emergency

Perhaps no one in recent memory has gained so much notoriety because of a lack of something than Terri Schiavo. What did she lack? Something that many people also do not have. She never prepared an Advance Directive stating her wishes concerning how she wanted to be treated medically in the event that she could not speak for herself. Had she done so, the fifteen-year-long, agonizing, life and death controversy that roused the American public, its lawyers, doctors, and politicians to heated debate, would most likely have been averted. Her story has much to teach the rest of us. Do you have an Advance Directive? Have you prepared a Durable Power of Attorney for Healthcare or a Living Will? Do you know what legal purposes these documents serve, and why you should have them? In today’s complex and legalistic health care system, it is vital that every adult prepare and carry one or preferably both of these documents in case of a medical emergency. Make your health care team — and everyone else involved — smile. Let us help you get yours completed today.

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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 being, 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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Epidural Blood Patch (EBP)

Is it really a patch? What is it used for? How is it done? If you don’t accept blood transfusions, would you have a problem with the EBP? This brief procedure, which is performed by an anesthesiologist, is explained in detail in this article. Such information is valuable to help interested readers develop their own answers to the latter question. Feel free to access all of the resources on Epidural Blood Patch: the main Wiki article, the section in our developing article entitled “Patients Who Refuse Blood Transfusion – FAQs”, and the NoBlood forum thread.

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Take a ride on the RSS train!

Take a ride on the RSS train! Join us as we embark on a journey that will lead us away from our overflowing and cluttered (In / JUNK) boxes (what's in YOUR Inbox?) that sap our patience and productivity to a world of peace and tranquility. Well, we'll have to wait a bit for the peace and tranquility. Together, we will learn how to be more informed, productive and organized in the time we spend on the web.

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Article Summary: Egg on their Faces

In 1998, the Cochrane Injuries Group did a meta-analysis of 30 randomized, controlled trials investigating human albumin administration in critically ill patients. The results showed that, in patients receiving albumin, the risk of death was 14%; whereas the patients who did not receive albumin had a much lower risk of death, only 8%. The results were published and widely publicized worldwide on T.V. and in print. There was immediate negative response on the part of the drug regulatory agencies, the plasma products industry, and the medical profession. The plasma products industry tried vigorously to prevent a decline in albumin sales as a result of the information contained in the study. However, albumin use declined drastically after the Cochrane analysis was published. This article, published in 2002, describes the original trials and the Cochrane study findings, details surrounding the opposing reactions, and the final result supporting the conclusion of the authors, namely that evidence from systematic reviews such as the Cochrane study can have significant effect on clinical care. Click here for options for acquiring the original article by Ian Roberts and Francis Bunn, both affiliated with Cochrane Injuries Group.

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NoBlood Professional Directories

We are continuing to update our Professional Directories. Did you know that our directories are the most visited features of NoBlood? How do we keep them current and accurate? Well, it is not because we this huge team of volunteers dedicated to this job. The accuracy of these directories depend upon you. Please take a moment to review our Directories. Do you know where the closest Bloodless Medical Center is to you? Do you know of one that we are missing or needs to updating? If so, please take the time to click on the “Feedback” button to let us know. If you are a Bloodless Program Coordinator, we especially appreciate your support in helping in this regard.

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Bloodless Medicine and Surgery Road Map

We are currently creating a comprehensive, yet concise, Bloodless Medicine and Surgery "Road Map". This Road Map will help members and visitors quickly navigate the growing wealth of information related to blood conservation and avoidance. For example, over the past 10 years, NoBlood has accumulated thousands of discussions and articles related to bloodless medicine and surgery. This Road Map will facilitate the tagging of this collective knowledge and expertise as well as future resources around discrete topics. With this Road Map in hand, we are confident you will find traveling the bloodless road richly rewarding and productive. Please feel free to click [edit] to suggest an adjustment. Don't worry about the format. Others will come behind you to further 'refine' your contribution.

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Spotlight: Doctors and nurses do not always respect patient choice.

In a new post in our Spotlight Forum, goudrea, a new member to NoBlood, reports her experience that "Doctors and nurses do not always respect patient choice". Some years ago, her sister was put under pressure to accept a blood transfusion despite her stated wishes, written and verbal, along with the fact that goudrea was present to back her up.

Have you had a similar experience? Was the outcome more positive from a healthcare perspective? What might have made a difference? We would like to hear from you. It is very easy! Once you are logged in, go to the Spotlight Forum and click on [New Thread]. Be sure to come up with a concise and meaningful subject. Our members who are doctors, nurses, and other clinicians: you are especially invited to report on experiences you may have had with bloodless medical treatment - a special patient, a really positive clinical outcome, an interesting success story from a medical standpoint - with a post in the Spotlight Forum. Relating our stories is very valuable and help us as a community to develop a sense of shared experience and possibilities. Special thanks to goudrea, for her recent contributions.

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Public Site Feedback

Members new and old, now is the time to let NoBlood know what you really think. We have created a new Public Site Feedback forum where you can let us know what you think about NoBlood. If you prefer that your feedback be private only to Site Administrators, you are welcome to post a comment in the Private Site Feedback forum. We appreciate the frequent comments we receive from people regarding how NoBlood helped them in some way. If this applies to you, please take the time to express your sentiments in the Public Site Feedback forum. If you found NoBlood useful or educational to you, please take a moment to relate how. Our first official feedback in this new forum comes from goudrea. After reading hers, why not take a moment to share yours ublic-site-feedback/">here?

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Unanswered Questions, Can You Help?

by Larry Eitel, NoBlood Webmaster

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

kidney transplant in Quebec, Canada posted November 24, 2006 by goudrea

Hello everyone, New to hd last july and looking foreward to a kidney transplant. New Jersey USA hospital is willing to perform a kidney transplant without the use of blood products however in Quebec so far impossible to obtain consent of a surgeon or team that is willing to perform the operation. Does anyone have knowledge of bloodless kidney transplant in Quebec? Sincerely M. L

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NoBlood Technical Team

Upcoming projects:

• The NoBlood Technical team is investigating the migration of the noblood forum to a new platform, Drupal, which seems to have some features that may be more useful.

• The NoBlood Technical Team is looking into creating a single-sign-on (SSO) system, so that the same username and password will work across all the areas of the NoBlood system, and once an account is created in one system, will give you access to all areas of the site. To this end, we may ask with assistance in various areas as needed.

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

This is just to remind all you very busy members to check through your hard drives, your files, and your folders, to see if you have written anything relating to blood conservation & avoidance that you could submit for possible publication here on NoBlood. Or, even better, write something now! If you haven't already read it, please see our previous article in the November NoBlood Bulletin for further details.

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Get Involved!

We know. Everyone wants you to get involved with their gig. But you are reading this because you like what you see on NoBlood. Maybe one of your family members needed urgent assistance with locating bloodless medical care. Maybe you needed to know what procedures might be involved during your upcoming surgery. Maybe you just had some research to do for a class, or just out of curiosity...and you found the answer here. People who know bloodless medicine were here to help you. Now, you can give something back to NoBlood. We want YOUR input, experience, enthusiasm, knowledge, or critical eye (can you spell? we NEED your editorial skills!).

"But," you protest, "I am not a doctor or a nurse. What do I know about this subject?" That is exactly the reason we want you to keep reading. Remember, NoBlood is a community. Every member of NoBlood has valuable talents and experience to contribute. Let us show you how! Check out the article “Get Involved!” which discusses the various ways you can help which only take a few minutes a day (less time than it takes to read one news or sports article). On our NoBlood forum thread "Get Involved", you can find some examples of specific members who have been able to give their time and talents in various ways. For example, it was a pleasure working with Doctor Loubser, an anesthesiologist, who compiled, with the assistance of our Editorial Team, one of our latest articles entitled, Epidural Blood Patch. He literally wrote this article in between stints in the OR! So if he can find time, you can too! You can do it! As always, we thank you for helping to make NoBlood the number one Site on the web for sharing bloodless healthcare knowledge and expertise.

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Thanks to you, we're growing!

by Larry Eitel, NoBlood Webmaster

For those of you who are curious, this page is dedicated to sharing key statistics as to the level of use of NoBlood. Lewis Carroll is quoted as saying: “If you want to inspire confidence, give plenty of statistics. It does not matter that they should be accurate, or even intelligible, as long as there is enough of them.” In this case, our purpose in presenting Site statistics is to make you aware of the increasing use of NoBlood and the increasing need for assistance in various ways as to accomodate this growth. In other words, we need your help! Building and maintaining a website that is currently averaging 650 visits a day and growing is a serious undertaking. Not only are expenses mounting but there is growing need for helping hands to assist in the various editorial and technical work involved in providing this resource. Please Get Involved!

In the weeks to come, we will share further statics as well as explain what they mean.

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Please Support NoBlood Today!

The end of the year is upon us. It is exactly the right time for all of us who have not yet done so to make a contribution to NoBlood. The impressive growth of our site cannot happen without certain financial outlays. Please set aside a few dollars to support the increasing expenditures that make it possible for this to be the most comprehensive and well-presented bloodless health care site on the Web. You know this can only happen with everyone's contributions, not just left up to a few long-time die-hards to bear alone. We want to recognize and support the efforts of those who work hard and spend not only time but money on behalf of all of our interests - not just with sentimental words of thanks ("Keep warm and well-fed..."), but with responsible financial contributions.

Let your minds be made reasonable and your hearts receptive. We all know it needs to be taken care of. If you haven't done it at least once, do it. There's a link in the upper right corner of each page of the Wiki and the Forum. It says "Your continued donations keep NoBlood running." Click it. I have. As a matter of fact, I just did it again. Join me.

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