EXPERTS SPEAK OUT Armed with such knowledge, a growing number of health care workers are taking a more critical look at transfusion medicine. Reports the reference work Dailey's Notes on Blood: 'Some physicaians maintain that allogeneic blood, (blood from another human) is a dangerous drug and that its use would be banned if it were evaluated by the the same standards as other drugs.' Late in 2004, Professor Bruce Spiess said the following about transfusing a primary blood component into patients undergoing heart surgery: 'There are few if any medical articles that support tranfusion actually improving patient outcome.' In fact, he writes that many such transfusions 'may do more harm than good in virtually every instance except trauma,' increasing 'the risk of pneumonia, infections, heart attacks and strokes.' It suprises amy to learn that the standards for administering blood are not nearly as uniform as one would expect. Dr Gabriel Pedraza recently reminded his colleagues in Chile that 'transufion is a poorly define practice,' one that make is 'difficult to...apply universally accepted guidelines.' No wonder Brian McClelland, director of Edingburgh and Scotland Blood Transfusion Service, asks doctors to 'remember that a tranfusion is a transplant and therefore not a trivial decision.' He suggests that doctors ponder the question, 'If this was myself, or my child, would I agree to the transfusion?' In truth, more than a few health care workers express themselves as did one hematologist, who told Awake: 'We transfusion medicine specialists do not like to get or to give blood.' If this is the feeling among some well trained indivicuals in the medical community, how should patients fee?' WILL MEDICINE CHANGE? 'If tranfusion medicine is so fraught with dangers,' you might wonder, 'why is blood still used so extensively, particularaly when there are alternatives?' One reason is that many doctors are simply reluctant to change treatment methods or are unaware of thereapies that are currently used as alternatives to transfusion. According to an article in the journal 'Transfusion'. 'physicians make tranfusion decisions based uipon their past teaching, enculturation, and clincical judgement.' A surgeons' skills also make a difference. Dr Beverley Hunt, of London, England, writes that 'blood loss is highly variable between surgeons, and there is increasing interest in training surgeons in adequate surciacal haemostasis (methods to stop bleeding.' Others claim that the costs of transfusion alternatives are too high, although reports are emerging that prove otherwise. Many doctors however, would agree with medical director Dr Michael Rose, who says: 'Any patient who receives bloodless medicine is, in essence the recipient of the highest quality surgery that is possible.' The highest quality of medical care - is that not what you would want? If so, you have something in common with the people who brought you this magazine. Please read on to learn about their remarkable stance on the matter of blood transfusions. DEATH BY TRALI Transfusion related acute lunge injury (TRALI) first reported in the early 1990's is a life threatening immune reaction following a blood transfusion. It is now know that TRALI causes hundreds of deaths each year. Expers, however, suspect that the numbers are much higher, as many health care workers do not recognize the symptoms. Although it is not clear what causes the reaction, according to the magazine 'New Scientist', the blood that causes it 'appears to come primarily from people who have been exposed to a variety of blood groups in the past, such as ...people who have had multiple transfusion.' One report states that TRALI is now near the top of the list for causes of transfusion related deaths in the US and Britain, making it a bigger problem for blood banks that high profile diseases like HIV.
NO BENEFITS TO BLOOD TRANSFUSION...?
by Gill 61 Replies latest watchtower medical
-
-
BluesBrother
There are about ten pages of this stuff , but here is one article.
The scans look ok on my screen. Let me know if they failed
-
Gill
Thanks BluesBrother!!! My little fingers were ready to drop off!!!
-
Marvin Shilmer
Hello, TD et al
I do not think it accurate to say Spiess was referring to only the augmentation of a patient's oxygen delivery via red cells.
The Spiess quotation comes from his article Risk of Transfusion: Outcome Focus published in 2004.
It is true that the lion’s share of this article addresses red cell transfusions, and it is also true that red cell transfusions are administered to increase oxygen carrying capacity. Nevertheless, the Spiess article intensely focuses on transfusions outcomes rather than therapeutic indications. Hence Spies highlights a range of problems impinging on good outcomes, one of which is the oxygen carrying capacity of red cells (particularly of banked red cells).
Additionally the Spiess article talks about platelet transfusions, and strictly speaking platelets are not transfused to increase tissue oxygenation but rather to protect tissue oxygenation from red cell depletion resulting from hemorrhage.
On the other hand, I do not agree with how the Awake article uses Spiess’ work. The Awake article leaves a reader thinking that Spiess believes 1) that only trauma is an indicator for transfusion and, worse that 2)
Spiess agrees with the WTS’ view on transfusion therapy, which he most certainly does not.Spiess’ article is pretty clear that more research needs to be done on transfusion therapy in order to determine better (optimal) patient indicators in order to protect patients from needless risk associated with blood. Spiess has not argued for ceasing blood transfusion medicine.
Telling by its absence is any reference to a later article by Spiess from 2005 wherein he plainly states, “Clearly, an appropriate or best practice for blood transfusion must exist. In massive blood loss cases, transfusion surely saves lives.” (Spiess, Blood Transfusion and Outcomes Research, Trauma Care Journal, Summer 2005: 152.
Furthermore, in the very Spiess article quoted by Awake we find Spiess depicting a distinction between transfusions of fresh red cells (less than 5 days stored) versus red cells stored for longer periods (banked blood). Since the majority of red cell transfusions are of blood stored longer than 5 days then much of Spiess’ comments are necessarily wrapped around that fact. For this reason Spiess calls readers’ attention to an editorial appeal to save fresh red cells for transfusion into the most ill patients who may need it, and to otherwise demand fresh blood rather than depending on banked blood. Hence we see Spiess arguing in favor of better guidelines for blood transfusion medicine. Certainly he is not arguing it is appropriate at this point in time to cease transfusing blood!
Marvin Shilmer
-
Ginosko
Hi,
I think that the following information is reliable. I obtain it from MedScape.
Bloodless intensive care: a case series and review of Jehovah's Witnesses in ICU.Anaesth Intensive Care. 2004; 32(6):798-803 (ISSN: 0310-057X)
MacLaren G; Anderson M
Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria.
The objective of this study was to assess the outcome of Jehovah's Witness (JW) patients admitted to a major Australasian ICU and to review the literature regarding the management of critically ill Jehovah's Witness patients. All Jehovah's Witness patients admitted to the ICU between January 1999 and September 2003 were identified from a prospective database. Their ICU mortality, APACHE II scores, APACHE II risk of death and ICU length of stay were compared to the general ICU population. Twenty-one (0.24%) out of 8869 patients (excluding re-admissions) admitted to the ICU over this period were Jehovah's Witness patients. Their mean APACHE II score was 14.1 (+/- 7.0), the mean APACHE II risk of death was 21.2% (+/- 16.6), and the mean nadir haemoglobin (Hb) was 80.2 g/l (+/- 36.4). Four out of 21 Jehovah's Witness patients died in ICU compared to 782 out of 8848 non- Jehovah's Witness patients (19.0% vs 8.8%, P = 0.10, chi square). The median ICU length of stay in both groups was two days (P = 0.64, Wilcoxon rank sum). The lowest Hb recorded in a survivor was 23 g/l. Jehovah's Witness patients appear to be an uncommon patient population in a major Australasian ICU but are not over-represented when compared with their prevalence in the community. Despite similar severity of illness scores and predicted mortality to those in the general ICU population, there was a trend towards higher mortality in Jehovah's Witness patients.As you can see, the risk for death in Jehovahs Witness patientes according this scientifc study, is more probably than for general population: 19% vs 8,8%. That's in the case of critical ill, when they avoid blood treatment.
You also could find other statisticals references that says that: One in 20 Americans will require a blood transfusion at some point in their lives.
With this numbers in mind, and knowing that they are 1,000,000 JW in USA, we could estimate that:
1. Of the 1,000,000 JW in USA, 50,000 will requiere blood in an emergency.
2. According the Austrain study, considering all the risk and causes. The JW's will have more probability to die: From the 8.8% of general population to 21.2%.
3. Translating this to numbers: Innecesary Deaths of JW = 50,000 * (21.2% - 8.8%) = 6,200.Why didn't the WTBT publish this study?
Cordially,
Ginosko -
FreeFromWTBS
These articles make me so mad. I hope they get sued into non-existence.
-
blondie
For more information please contact Dr. Bruce Spiess at [email protected]
-
Marvin Shilmer
Hello, Ginosko
I appreciate your statistical attempt, but it does not paint an accurate picture.
The study you cite provides comparative death rate for Jehovah’s Witnesses admitted to Level III ICU facilities in Australia. It is not useful for determining mortality or morbidity resulting from all cases of blood transfusions among Jehovah’s Witnesses.
Readers can see more about this review of ICU outcomes published in Australia here:
http://www.jehovahs-witness.com/16/103777/1795339/post.ashx#1795339
Marvin Shilmer
-
TD
Hiya Marvn,
I do not think it accurate to say Spiess was referring to only the augmentation of a patient's oxygen delivery via red cells.
Spiess has made virtually the same comment in numerous seminars. I believe his statements are directly related to his advocacy of perfluorocarbon based blood substitutes, but alright, point conceded. He definitely mentioned platelet deficiency as well.
Nevertheless, (IMHO) the JW usage of his quote is still fallacious for the reasons I stated. Spiess was specifically talking about cardiac surgery and not about other fields, like pathology, where there are a number of unique transfusion scenarios.
-
Ginosko
Hi Marvin, Thanks for your informations. Sorry for my bad English. I didn't study medicine, but as I understand, ICU level 3 is a very specialiced ICU, in which facilities the deaths drops considerably, compared with other ICU facilites, because of better protocols and cares. In the following link we could see a USA 1992 statistics of about 4,000,000 admitance a year for ICU facilities, with 500,000 deaths a year.
http://www.sccm.org/SCCM/Professional+Resources/Quality+Corner/Success+Stories/QualityCornerSuccessStoriesTale.htm
From this numbers we could estimate a 12% estimate of probability of deaths for those admited in a ICU facility.
The Australian study talks of a 8.8% of deaths for his ICU level 3 facility. We can see the benefits of better protocols and treatments.In my previous estimate I did the followings statements:
1. Of the 1,000,000 JW in USA, 50,000 will requiere blood in an emergency.
2. According the Austrain study, considering all the risk and causes. The JW's will have more probability to die: From the 8.8% of general population to 21.2%.
3. Translating this to numbers: Innecesary Deads of JW = 50,000 * (21.2% - 8.8%) = 6,200.
But, as we could agree, this number apply only in the ideal case t hat all JW will obtain the better treatment avaliable in our hospitals. In others ICU facilities, the number of innecesary deaths will grow.
So 6200, is the low estimate number of innecesary deaths because of the bloodless teaching of the WTBT. If we consider all the ICU facilities, a better estimate could be:- Percentage deaths of patients in all ICU facilities: 12%
- Percentage deaths of patients in ICU Level 3 facilities: 8.8%
- Innecesary deaths of JW for all ICU's facilities: 6,200 * (12% / 8.8%) = 8,455.
The number 8,455 is only an estimate, before we have a definitive study about this topic.
Cordially, Ginosko
