The following is an essay I wrote for my Eng 101 class a few years ago.
This is an example of pre-doubt me.
Although my theological motivations for writing this piece were clearly
suspect, I stand by the medical information I found.
(Sources) available upon request.
Comments and criticism welcome.
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"Bloodshot"
Contrary to what it may feel like, the most precious liquid you possess is not the gasoline in your car. It is not the fuel oil sitting in your basement. It is not even that bottle of scotch in your den that is older than you are. Rather, it is the blood rushing though your veins, and it has a current replacement value of $20,000 (Basha). But does blood really have a price tag? Well, you cannot go to the blood store and stock up on a few units for your peace of mind can you? Once blood falls out of your body, its gone for good. The only option you have is to make more, and this takes time. Weeks worth of time: Time you do not have if you are busy bleeding to death. So, doctors have done their best to find something to take the place of this priceless red liquid. An oil painting from 1982 by Jules Adler depicts a woman receiving a blood transfusion from a live goat. Not surprisingly, the woman died. So did a lot of other people until 1901 when the concept of blood type was introduced to the world (Cwanger). Just because something looks like your blood does not mean it will act like your blood. Although advances in medicine have thankfully brought us past draining live goats, the basic tragic misconception survives that a blood transfusion is an easy and safe solution.
Far too often, rather than being a miraculous cure, blood transfusions contribute to transmission of disease, a weakened immune system, increased recovery time, as well as enabling and sustaining clumsy and ill-informed medical protocol. The true solution lies, not in a safer and more copious blood supply, but in lessening or eliminating the routine use of blood altogether. This can only be accomplished by properly preparing a patient’s bloodstream ahead of time, reducing blood loss during surgery, and carefully questioning how much blood loss will be tolerated before a transfusion is resorted to. This will reap rewards both for the health and welfare of the patient and the ultimate financial health of the hospital. Before that however, we need to explore the seldom discussed downsides to the practice of routine blood transfusion.
The most obvious risk involved in taking someone else's blood into your body is transfer of disease. If the blood donor is sick, so is his or her blood. According to the World Health Organization (WHO), “around the globe, unsafe blood transfusion and injection practices cause some 5 million Hepatitis C virus infections each year” (“Transfusion”). Hepatitis C has no cure. If you acquire the disease, you will carry it for years before it slowly begins to kills you (“Hepatitis”). Of course, Blood donors are screened for all known forms of Hepatitis before being allowed to give blood, but as seen by the WHO statistic, virus mutation and user error make this screening process far from infallible (“Hepatitis”). Sometimes lost in the shadow of outright disease transmission is a far more insidious and unavoidable downside to blood transfusion.
Because a unit of blood hangs innocently beside the hospital bed next to your morphine and your saline drip, it is easy to think of blood as a medicine. It is not. A blood transfusion is an organ transplant (Ozawa et. al). In the words of Dr. Jan Seski of Allegheny General Hospital: “When you [receive] blood, it is a tremendous immunological insult to the body. It's all foreign protein- It's somebody else's blood! Even though it is matched to the person, the white cells are different, all these antibodies... (sic) It just overwhelms the body’s immune system and plugs it up for awhile” (Roth). Now crippled in the effort of trying to get along with the hordes of foreign invaders recently introduced to it your bloodstream not only cannot ward off legitimate threats from an airborne virus or bacteria, it also cannot offer its full services for another vital task: Healing the gaping hole left in whatever organ is causing the blood loss to begin with. This weakening of the immune system will often lead to the next downside.
In a recent study done on similar heart bypass patents, those that did not receive blood transfusions had an average hospital stay of 11.9 days. Those that did receive blood had an average stay of 14.4 days (Worchester). Considering that room and board at a hospital can cost upwards of $2,000 a night, the food is terrible, and all the other guests mostly occupy themselves by spewing out germs that your body is now too weak to defend against, that number matters. The costs incurred from this increased hospital stay, added to personal and technical costs, mean that although a single unit of blood costs at face value about $200, the actual end cost to the patient hovers between $1,600 and $2,400, and if you ever do receive a blood transfusion, it will likely be at least 3 units(Basha). In light of these disturbing facts, Joseph Basha concludes that “scientific literature is replete with irrefutable data showing that allogeneic [someone else's blood] transfusions, although at times an absolute necessity, are in fact detrimental to short, intermediate, and long term outcomes” as well as causing “increased infection rates, prolonged ventilator times, disease transmission, allergic reactions, cross match errors, lung injury, [and] increased mortality”(Basha).
Flying in the face of this looming wall of downsides, however, is human nature and the powerful forces of habit and tradition. Remember the bypass surgery study mentioned above? The only reason those patients were given blood was because it was the routine thing to do. This study is not alone. According to Michaela Willhelmi of Jena University Hospital, “Fresh frozen plasma substitution [blood plasma transfusion] is currently standard practice in cardiac surgery”(Greer). However, when the practice was looked into, the study showed that no benefits resulted from the practice, and in fact some evidence pointed to outcomes being better for the patients not receiving the plasma(Greer). Despite their obviously pointless and occasionally dangerous nature, routine blood transfusions continue to flow from the hands of unquestioning doctors into the veins of unquestioning patients.
Someone needs to start asking questions, perhaps starting with this one: Why? What would be the motivation to so frequently turn first to a treatment that should be a last resort? One possible answer: It is the easy way out. Dr. Seski, quoted earlier, continues: “I'm going to be honest with you: Not all surgeons can do this because not all surgeons can do surgery without losing an excessive amount of blood. [...] Certain people can do operations and lose a lot less blood than others”(Roth).
Surgeons are technicians. They just happen to be technicians to whom we entrust our very lives. Would you let someone fix your priceless antique watch if you knew he had the reputation for losing dozens of tiny screws and springs in the process? Like any other tactical skill, surgery without collateral damage requires a high level of mastery. Within the present system of things, as long as the technician can simply reach for a bag of new parts, he has no motivation to work particularly hard at saving the original ones- The problem being that if those parts happen to be red blood cells belonging to your bloodstream, there is no bag of replacements. All a blood transfusion does is take a bag of similar parts and forces them to fit. Until this system is fundamentally changed, the casual transfusion of blood will continue to enable the gravity fed behavior of sloppy surgeons.
Some will say, as Carla Arnold did in her letter in reaction to the Roth piece quoted earlier, that articles such as his and the one you are reading dangerously minimize the need for transfusions to the point were she will find herself “in an emergency, need blood, and not be able to get it because of a lack of blood donors.“ True, as people become informed as to the outdated and overused nature of blood transfusions, they may start to view blood donation as less important, and the overall levels in the blood banks may go down. And granted, there are some occasions of catastrophic blood loss, such as severe trauma car crash that the choice is between a blood transfusion and likely death (Roth). In these cases, unless the patient objects for religious reasons, doctors will be thankful for the blood supply they have access to that allows then to save that patients life. However, blood transfusion alternatives will in fact decrease the demand for blood in other non-trauma cases, therefore increasing the available amount of blood in the donor pool(Roth). Added to this is the possibility that deceased trust in and availability of blood may actually create motivation to conserve blood both inside the patient and out.
In order for bloodless surgery to be a truly viable option however, doctors need to think ahead.
In this particular context, the most important part of your blood is the red blood cells- the cells that carry oxygen around. The more red blood cells you lose, the less oxygen is transported to important organs, like your brain (“Transfusion”). This is called anemia, and when it gets bad enough, you die. Red blood cells are made in the bone marrow, and hormones, iron, B12 and folic acid can be given to the patient to encourage rapid red blood cell production (“Transfusion”). This means that the patient goes into surgery with a higher cell count to begin with, so there is a larger margin of safety. Some forward-thinking doctors will capitalize on this newfound excess of red blood cells with a technique called hemodilution: Blood is drawn from your body, and a machine removes the red cells. The missing cells are replaced with saline solution, and the red-less blood is pumped back into your body. This means that during surgery, every pint of blood you lose will be worth somewhat less, because it was diluted. True, you still lost blood, but the really important part of the blood is sitting safely in a machine next to you, ready to be returned home to your bloodstream as soon as you get sewn up (Roth).
Of course, the best way to “find” blood is to not lose it in the first place, and that brings up the next critical building block of bloodless surgery: Minimizing blood loss during surgery. The first way to do this is obvious: Make smaller cuts. Fewer cuts mean fewer leaks, and fewer leaks mean more blood stays where it belongs. Thanks to advances in both technology and doctor skill, this is becoming increasingly possible. When a large cut does need to be made, the right knife makes all the difference. Tools like the gamma knife, ultrasound, and argon beam actually use sound and heat energy to seal up the edges of the wound as it is made, greatly lessening blood loss (Ozawa et. al). Of course, bleeding is going to happen despite even the best technology and most masterful fingers. However, just because the blood escapes the veins doesn’t mean it is lost for good. A “Cell Salvage” machine is used to carefully vacuum up the escaping blood, filter it, and put it right back into your vein (“Transfusion”).
Finally, how a patent is treated after surgery is an essential facet of bloodless surgery. Normally, after all is said the done and the patient is all stitched up, their doctor will take a damage report to find out how many red cells are left. If the number that gets spit out of their machine is less than 10 grams per deciliter, a blood transfusion is automatically ordered(Kirschman). Sounds fine, until the matter is looked into and someone points out the fact that this is a completely arbitrary number with no scientific backing(Kirschman). The origins of this tradition can be traced back to a few doctors opinions published in a 1942 medical article. Nevertheless, this number acquired a near gospel colored aura, and was seldom questioned (“Transfusion”). What forward-thinking doctors are now coming to realize is that patients own blood production should encouraged via the same blood-boosting treatments mentioned earlier, rather than given up on and abandoned in favor of the quick and mindless path of automatically triggered blood transfusions (Kirschman).
After coming to terms with similar facts in their own finding, the CVT Institution in Louisiana made some much needed changes to implement many of the solutions discussed in this article, including updating their technology, changing hospital policies and educating their staff. Today, the average cardiac patient at their hospital receives less than 1 unit of blood during their stay. The national average is 7.6 units(Basha).
Reducing the use of blood is also beneficial to the financial health of the hospital. One Cardiac center, after implementing a similar program, realized a cost savings between $480,000 and $720,000 each year.
If you happen to be a patient in one of these cutting edge hospitals, you will likely be automatically benefiting from the enlightenment of someone who came before you and cared enough to ask questions. Clearly, however, other studies discussed here show that many medical programs are lagging behind the enlightenment of the industry, choosing instead to hide in the comfortable shadows of traditional protocol. If you find yourself under this type of well-meaning but entrenched medical care, it is up to you as a patient to be the one to start asking questions. Your body is your responsibility. You have the constitutional right to accept, reject or question the medical decisions that hold your life in the balance.
Routine blood transfusion is clearly out of step with modern medicine. In the end, however, all of these brilliant ideas are only of value if patients are respected and informed enough to take an active role in their own health care, and doctors are humble enough to acquiesce to the fact that there might be a better way to fix a woman than injecting her with the blood of a live goat.