Quality Alternatives to Blood Transfusions

Non-Blood Management is Available and can be Safer to Patients

Oct 6, 2008

Alternatives to Blood Transfusions are Available, click

There is increasing evidence that blood transfusions are dangerous and often unnecessary. There are many safer options available to patients.

These days many people avoid blood transfusions, either for religious reasons or for health reasons. "Blood transfusions can have a number of deleterious consequences" cautioned Dr. Spence, Chief of Surgery at St. Agnes HealthCare in Baltimore. He adds "Perhaps the best way to think about transfusions is as 'liquid organ transplants' ".

Individuals who want to avoid blood still, of course, want to have high quality and effective medical care. Are there effective ways to manage serious medical problems without using blood? Happily, the answer is yes.

Alternatives to Blood Transfusions

Blood volume can be replaced without using whole blood or blood plasma in cases where large volumes of blood have been lost. Various non-blood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as Dextran, Haemaccel, and lactated Ringer's solution. Hetastarch (HES) is a newer volume expander, and "it can be safely recommended for those [burn] patients who object to blood products." (Journal of Burn Care & Rehabilitation, January/February 1989)
One way to avert the risks and costs of blood transfusion is simply to avoid the procedure whenever possible. "Avoidance is usually fairly safe and well tolerated even for patients with a low hemoglobin level" states Aryeh Shander, MD, Chief of Anesthesiology and Critical Care at Englewood Hospital and Medical Center in New Jersey. Tranexamic acid, a lysine analogue which inhibits plasminogen activation and fibrinolysis, can be used to prevent excessive blood loss in a number of clinical settings.(1)
Recombinant Erythropoietin - Kidneys produce a hormone called erythropoietin (EPO) which stimulates bone marrow to form red cells. Now, synthetic EPO is available. "Recombinant Erythropoietin should be on everyone’s mind as the first drug of choice to treat anemia in patients who do not need to be transfused. Although recombinant erythropoietin is usually given pre-operatively, it can be used during surgery in trauma and obstetrics cases" says Dr. Shander.(1)
Blood-conservation methods such as electrocautery, which minimizes bleeding, can be used by skillful surgeons. Sometimes blood flowing into a wound can be aspirated, filtered, and directed back into circulation. Diathermy is commonplace in theatres to keep the surgical field clear and to reduce blood loss. During surgical procedures, it is now common practice to use heated water blankets to maintain body temperature.
Patients on a heart-lung machine primed with a non-blood fluid may benefit from the resulting hemodilution, fewer red cells being lost. (2)
Cooling a patient to lessen oxygen needs during surgery, Hypotensive anesthesia, Therapy to improve coagulation, desmopressin (DDAVP) to shorten bleeding time, "Laser"scalpels are some of the other alternatives employed in non-blood management. (2)

The points above have scratched the surface of the alternatives available for blood transfusions. In all cases where an individual is concerned about health and safety, careful research on blood alternatives needs to be done in advance to ensure the best outcome. In addition, there are a growing number of medical centers that recognize the benefits of bloodless medical care and are willing to provide such care to patients.

Significantly, organ transplants, joint replacements, heart transplants, obstetric operations and even brain surgery are procedures that have been successfully performed on patients without the use of blood or with an alternative to a blood transfusion. With an increasing demand for non-blood management, no doubt research will continue in this field in the hopes of finding even better solutions in the future.

References:

Pulmonary Reviews - Blood Transfusion Risks and Alternatives Volume 9, No. 2, 2004
How can blood save your life? Subheading: Quality Alternatives to Transfusion - Watchtower, Bible and Tract Society of Pennysylvania.