Dear Brothers and Sisters:

I live in Santo Domingo Este, Dominican Republic, 30 minutes from Puerto Rico and 2.5 hours from Miami. We can get Eprex 2000 Units at an approximate price of US$25.00. Also Eprex 4000 Units at an approximate price of US$50.00. Both of them without albumin.

This medicine is distributed in this country by Novartis Laboratories. For a quick answer, contact Javier Valentin (e-mail jvalentin@sdtj.org 6 phone 809 595 4007) who is the brother in charge of the Hospital Information Services for JW here.

I hope we can help.

José R. Luciano S.

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Dr. José R. Luciano S.

Our hospital recently talked with the Witness Organization to help us get Albumin-free products from another country. They do not have the jurisdiction to help with that. The drugs are not approved by the FDA here in the United States and they cannot bring drugs across the border in the manner described in the recent forum discussions. I thought everyone would like to know that so that they did not ask.
Elora Thorpe RN
St. Luke's Hospital of Kansas City

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Elora Thorpe RN BSN
Coordinator
Blood Conservation Program
St. Luke's Hospital of Kansas City
Kansas City, MO. 64111
816-932-6183

Seeing that the patient made an informed decision against the use of fractions derived from a primary component. Would not Novo Seven be out of the picture as well as platelet gel?

Novo Seven is albumin-free but is used for a totally different purpose than you are referring to. Also, there are some recombinant gels and glues on the market but not very popular with surgeons and they are expensive.

As an update regarding this situation. Hospital Information Services within the Watchtower Bible and Tract Society in Brooklyn, NY, is unable to intervene in these types of situations. This would be a pandora's box for obvious reasons.
This patient is pursuing locating a physician in Windsor, Canada in order to be treated with Eprex.

Thank you for your input.

Debbie Tolich

Did anyone consider going to surgery at 11 grams? I find that 'at times' my surgeons ask mainstream questions based on debunked assumptions i.e. need for topped off hemoglobin when they should be focusing on blood alternate solutions such as quick to surgery, meticulous technique, cell salvage, hemostasis etc. before it falls any lower. They chase after the red herring meanwhile more time passes co-morbidities make their presence known and the patient now has increased Hg by two grams but can't have treatment.

My role in house - I am there to advocate and educate. I am there to break the paradigm. I am there to effect physician practice.

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Occam's Razor

one should not increase, beyond what is necessary, the number of entities required to explain anything

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

I understand. Thanks for this information.

José R. Luciano S.

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Dr. José R. Luciano S.

Jan,

You present a good point. I agree that as patient advocates we need to think outside of the box and discuss with physicians all possible scenarios. In this particular case the risks outweigh the benefits. This patient is stable at this time and with the co-morbidity of significant liver disease it would be placing the patient at unnecessary risk.

In an emergent situation, the physicians I work with do not exclude anyone from surgery due to anemia. As a matter of fact, last summer we received a JW acute MI that was immediately cathed/angioplastied and given Plavix and went into cardiogenic shock with a poor prognosis for survival. One of our cardiothoracic surgeons took him to surgery as a last resort attempt to prolong life. I don't know of too many CT surgeons willing to take someone to surgery within 24 hours of receiving Plavix. This particular patient did not survive. However, everyone involved in the care of this patient went home at the end of day knowing that everything possible was done.

I appreciate this website for the exchange of ideas and experiences.

Debbie Tolich, RN
Director
Regional Center for
Blood Conservation
St. Vincent Charity Hospital
Cleveland, OH
216-363-3353

This certainly has been an interesting ongoing discusssion. I would like to make a couple of comments.

First, patients with compromised liver function will likely have difficulty with postop hemostasis. I don't recall anyone bringing up that aspect. However, it is probably the single most critical risk factor because of the inability to quantify. You just can't predict who bleeds postop and who doesn't. Even with a bumped up crit, if they bleed and don't stop, they die. Add all of these factors add up: double valve, cirrhosis, crit is low and can't use EPO, refuses fractions....I think medical management is the reasonable solution. (Keep in mind that ongoing anticoagulation in a Jehovah's Witness carries it's own risk over the long haul, too)

Second, from a financial perspective, resources are limited and exposing a patient to a costly procedure and hospitalization with little prospects for a good outcome affects the entire system.

Just a thought.....
Jo

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Jo Valenti, RN
CBMS
Kennedy Health System

Our physicians are the experts at what they do, but new information often changes their approach. My purpose wasn't to impugn the surgeons in this case, however I know from many years experience that our job as bloodless pros is to be brave and ask the tough questions. We must resist the current standard of care rut. We must admit that some surgeons "think bloodless" better than others. I still experience the old "if they won't take blood there is nothing we can do" syndrome. Don't you? When we challenge that we are not questioning the physician's judgment we are simply doing our job, which includes bringing a new perspective to difficult cases.

I have gotten used to questioning the premise (in a very tactful way). Until non-blood alternative treatment becomes the standard of care I will need to continue doing so.

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