For a variety of reasons, some people feel strongly about refusing blood transfusions and blood products. Bloodless medicine is an emerging medical practice that seeks to provide full medical care, including surgery, for these patients without the use of transfusions.
There are many legitimate reasons why a patient might wish to refuse blood products. Perhaps the most well known are the religious beliefs of certain groups, especially Jehovah’s Witnesses. But religious beliefs are not the only reason someone might choose bloodless medicine. Some of these reasons include:
- Ethical decisions about the limited supply of blood available
- Patients with rare blood types may not have access to donor blood
- Fear of receiving the wrong blood type, which can cause a significant allergic reaction
- Concerns about infectious diseases that could possibly infect the blood supply, such as HIV, Hepatitis B, Epstein-Barr, or Mad Cow Disease
When it comes to surgery, bloodless medicine succeeds by increasing the amount of red blood cells a patient produces before surgery, replacing any lost blood with fluids, carefully managing the patient’s health during surgery, and meticulously controlling blood loss so that as little bleeding as possible occurs.
Preparation begins by increasing the number of red blood cells the patient produces, so that any loss during surgery will not be as harmful. Patients may be instructed to eat iron-rich foods, given iron supplements, or given medications to increase their hemoglobin. The least invasive surgical procedures available will be chosen, as they require tiny incisions.
During surgery, patients are often positioned on a slope with their head lowered, to protect their brain from any blood loss. Their blood pressure may be lowered and their body temperature raised to reduce bleeding. They may be given 100% oxygen to help a reduced number of red blood cells carry sufficient oxygen to their body. Modern surgical tools are used that cauterize any broken blood vessels as soon as they are cut, in order to minimize blood loss.
Sometimes, a technique known as hemodilution is used. A portion of blood is removed from the patient at the beginning of surgery and replaced with fluids, diluting the blood circulating within the body. If bleeding occurs during surgery, the blood lost is this dilute blood, and not as critical. After surgery, the pure blood is replaced. In some cases blood that is lost during surgery can also be collected, cleaned, and returned to the patient.
Not all surgeries can be performed bloodless, but most can, including:
- Open heart surgery
- Liver transplants
- Urinary tract surgery
- Hip and knee replacements
- Brain surgery
Despite all the precautions taken, during any surgery there is the possibility of unexpected hemorrhage. A hemorrhage, or severe episode of bleeding, can be life threatening without the help of transfused blood. Before any surgical procedure, it is important to make a plan with your physicians about what steps you would like them to take, or not take, in case the unexpected happens.