Bloodplates... Can it Really be Justified?

by mrbunyrabit 51 Replies latest watchtower medical

• 

  Marvin Shilmer

  Warm fresh whole blood transfusions are still common in the treatment of battlefield injuries, especially in forward units. Advances in pathogen reduction have made them successful enough in Afghanistan and Iraq that there has actually been speculation that they could become more commonplace in civilian applications again.

  A 2009 study of 66,369 women who gave birth at Parkland Hospital of Dallas County, Texas between 2002, and 2006 found that of the 1,540 treated with transfusion 659 (43%) received only whole blood.[1]

  Whole blood transfusion continues to be used by contemporary medicine for certain patient presentations, such as hemorrhage related to maternity.

  Marvin Shilmer

  http://marvinshilmer.blogspot.com

  ____________

  Ref.

  1. Alexander et al, Whole Blood in the Management of Hypovolemia Due to Obstetric Hemorrhage, Obstetrics and Gynecology, June 2009, Vol. 113, No. 6, pp. 1320-1326
• 

  Marvin Shilmer

  Regarding transfusion of whole blood,

  In addition to all the other fine contribitutions here on the subject, it should not be forgotten that autologous blood transfusions are routinely given as whole blood rather than as components. One variety known as preoperative autologous blood transfusion is prohibited under current Watchtower doctrine.

  Marvin Shilmer

  http://marvinshilmer.blogspot.com
• 

  NewChapter

  I still have my medical directive. It took a few years before I yanked it out of my wallet (when I carry one). It is now sitting in my car's ashtray. Every now and then I take a gander, if only to see my friends' signature. We had some GREAT times. It's just a pity all the way around

  You should get that out of there! What if you had a car accident and the emt's saw it?

  NC
• 

  Shawn10538

  To TD and Marvin Shilmer, can we see a reference on your information?If it's on this thread somewhere I'll look for it since I haven't read the whole thing yet.

  Also the following:

  1. Why is it important to mention, even if it is true, that "whole blood" (definition still not made in this conversation) is used on battlefields? Do JWs go to war? Are any of us on the battlefield right now? so to this point again I say, if it only exists on battlefields, then for all of us here, not on a battlefield (battle field needs to be defined as well since we don't really have battlefields since WWI. These days "the front" is not really the same as it was in the old days. "Hot Spots" is the phrase now used in battle, because of modern weapons. There is no "front line" ever since armies stopped lining up in actual lines and shooting at one another. So, I really don't know what you are talking about when you sAY "BATTLE FIELD.") fOR ALL PRACTICAL PURPOSES, WHOLE BLOOD TRANSFUSIONS DO NOT EXIST. End of story unless you can give me a good reason to talk about battlefield situations and JWs.

  2. as to the claim that someone somewhere is looking at whole blood transfusions again and thinking maybe we should do more of them, well, where is that reference, who said it, and what was the context?

  3. I believe that we need to set aside this phrase for a very good reason. It will save lives. If JWs have no medical procedure to point to as "whole blood transfusion" then they will be stymied as to be able to point at exactly what it is that they are so opposed to. I don't believe that any JW is ever pressured to accept a whole blood transfusion these days. So this being the case, a JW will be forced to really spell out exactly what it is that they are objecting to. It will then come down to:

  1. "I object to white blood cells" No worries, we didn't want to give you one of those anyway.

  2. I object to platelets." OK but you take clotting factors which is essentially platelets, so exactly what part of the platelet do you object to? The JW will not know what to answer. Then it will be that much easier for the doctor to say, "Well, you are allowed all these clotting factors, and I just informed you that clotting factors are essentially platelets and they are allowed by the WT, so what say you just take the rest of the platelets?" What could they say? If the doctor really felt that they needed the platelets whole and not just a derivative, then, he would be able to do that, talk the JW into accpeting them much easier. This is the upside to stopping the use of the term "whole blood transfusion." Saving lives.

  3. "I object to whole red blood cells." OK, we'll just put these red blood cells in a little machine and spin them around and then you'll accept them right? "Uh, yeah I guess so." Well if the doctor needs them to accept whole red blood cells after already administering hemoglobin (red blood cells are essentially sacks of hemoglobin) then he can say, "Well, you already took a transfusion of red blood cells that had their sack linings punctured. WQhy don't you just take a few in-tact red blood cells since you have already taken so many punctured red blood cells. what's the difference?

  It will make the JW really realize just how fine a line there is between what they already accept and what they could accept if they took everything available to them. The knowledge about blood really makes one realize that JW leaders are really getting down to the nitty gritty on the things they will accept and the things they won't.

  When you force the JW to get just as nitty gritty with what they individually accept, then it will REALLY seem INSANE for a person to get DAd over for example accepting just one tiny little bit more than the last person accepted, whole platelets instead of a major dirivative of platelets, an in tact red blood cell as opposed to a red blood cell that had a tiny hole punched in it... you get the point, hopefully.

  So I am asking Marvin Shilmer to lay aside the notion that whole blood transfusions are a sticky point with JWs. The fact is that no JW is ever going to be pressured to accept a whole blood transfusion, as defined as: blood that has been donated and that has not undergone ANY processing that might take away any part of blood however small.

  I am saying we should be strict in how we use the word whole. Whole is 100%. 99.9% is not whole. If ANY tiny bit of blood has been processed out, like for example, if the blood has been heat treated (as all blood is) then there are microscopic particles in the blood that evaporate. Once heat treated the blood is not whole anymore. It can then be called fractionated blood, something thaT A JW would be OK with taking. Get it? Saving Lives.
• 

  Shawn10538

  I am curious about how the Army handles blood, if it indeed uses whole blood. As I mentioned before, platelets must be kept moving and warm. Red Blood cells must be refrigerated. Plasma must be frozen. So if you had a bag of whole blood, what would you do with it? Freeze it? Refrigerate it? Or keep it warm and moving back and forth?

  Thios is a serious question. But I don't believe yet that any blood is stored with all its parts together due to the problems I just mentioned. If a doctor wanted to give a patient all parts of blood, he/she would have to order red blood cells in one bag, plasma in another and platelets in yet another. but it would not all be from the same donor. As I learned at the red Cross, blood donated from one donor does not get kept together. It will likely go to three different hospitals. So if you get a transfusion of all parts of blood, you will get it from three different donors. You will not get a transfusion of white blood cells. (If white blood cells are present with red blood cells that may be, but I haven't found a use for "just white blood cells" to be packaged on their own. Where white blood cells are taken out, there won't be many in the blood, but you will never see a bag of JUST WHITE BLOOD CELLS. it has no medical value that I have found yet.

  So I gues this is yet another reseaRCH thing I'll have to do. But again, none of us are on the battlefield so it's a moot point.
• 

  Shawn10538

  and let's keep autologous blood transfsuoon out of the whole blood debate since we are talking about what hospitals have available to them from blood banks. Autologous transfusions are a different subject. I'm not sure to what degree autologous blood needs to be cleaned before having it put back into one's body, but I concede that it could be ALL put back making it whole blood.

  If your purpose in talking about blood is to save lives, as mine is, and you want to massage JWs into accepting autologous blood transfusion you should do what the Indian doctor did in the article I have on AJWRB. The woman a JW accepted her own blood after it had been out of her body six hopurs. She was not DAd or DFd for this. therefore we have anecdotal evidence that JWs are accepting autologous blood transfusions of their blood that has been sitting around, probably circulating, for six hours. If they will accept their own blood six hours old, then maybe they will accept 7 hour old blood. Then 8. Then 9. and so forth. In other words, they are already accepting autologous blood transfusions. It's just a matter of how long it has to be out of their body as to whether or not they will accept it.

  Calling autologous blood transfusion a "whole blood transfusion" may make a JW not accept it on those grounds. So I would say it actually might kill some people if we go around saying that ABT are whole blood transfusions. Let's not do that, OK? Let's just keep our efforts on actually saving real lives rather than 'being correct." Being right in this case may cost JWs their lives. I don't want that.
• 

  Marvin Shilmer

  Shawn,

  Over the past 40-50 years transfusion medicine has gone from predominance of whole blood to mostly component therapy in developed countries. Hence in developed countries we find transfusion of whole blood in specific situations such as hypovolemia related to childbirth.[1] One reason for this is because blood is an intricate composition, and if we lose a lot of blood at one time then replacing just one or two or three of its constituents leaves our cardiovascular system vulnerable. In this case doctors will attempt a 1:1 ratio of all blood components to construct what amounts to a whole blood transfusion, or else they’ll just transfuse whole blood.

  Then we have developing countries where medical facilities, training and resources are reduced by comparison with developed countries. In developing countries is it not uncommon for doctors to treat patients with whole blood transfusion.[2]

  Also, clotting factors are not the same as platelets. Platelets are one component in hemostasis. The article Physiology of Hemostasis by Dr. Wayne Chandler is an excellent resource to learn more about this subject.[3] Particularly on page 78 you’ll find an illustration showing the process and how platelets function within it.

  I think the only reason military medicine has entered this discussion is because recent field experience has shown marked results with whole blood transfusion, and this has caught the eye of civilian doctors particularly in developed countries.

  Marvin Shilmer

  http://marvinshilmer.blogspot.com

  ____________

  Ref.

  1. Alexander et al, Whole Blood in the Management of Hypovolemia Due to Obstetric Hemorrhage, Obstetrics and Gynecology, June 2009, Vol. 113, No. 6, pp. 1320-1326. This is a study of 66,369 women who gave birth at a single hospital (Parkland Hospital, Dallas, Texas) between 2002 and 2006. A review of records found that of these 1,540 were treated with transfusion, and 659 (43%) received only whole blood transfusion.

  2. Holcomb et al, Optimal use of blood in trauma patients, Biologicals, January 2010, Vol. 38, No. 1, pp. 72-77. This is a good resource on the subject of transfusion of components versus whole blood. It gives a broad overview of the subject covering the hematological and societal aspects affecting the medical deliverable.

  3.Physiology of Hemostasis by Dr. Wayne Chandler in the book Perioperative Transfusion Medicine – 2 nd Edition, edited by Drs. Bruce Spiess, Richard Spence and Aryeh Shander, (Lippincott Williams and Wilkins, Philadelphia 2006), pp. 77 - 92.
• 

  TD

  Shawn,

  To TD and Marvin Shilmer, can we see a reference on your information?

  An interesting starting point would be the article, "A Fresh Take On Whole Blood" appearing in the February 2011 issue of Transfusion

  Why is it important to mention, even if it is true, that "whole blood" (definition still not made in this conversation) is used on battlefields?

  You mentioned battlefields. (I captioned the comment) I was simply responding. However there is a very long history of medical procedures developed in military conflicts being adapted to civilian use if they have proven efficacious, so I think the observation is pertinent.

  We can quibble about the applicabilty of the term, 'Battlefield' but that's neither here nor there. The U.S. military categorizes surgical facilites into levels. Low level (Austere environment) surgical facilities are typically closer to where the bullets are flying.

  I believe that we need to set aside this phrase for a very good reason.

  I understand your strategy here and agree with it. I don't know if you read any of the original articles on the AJWRB website, but there was one entitled, "What is a Blood Transfusion?" that attempted to make the same point.

  I object to platelets." OK but you take clotting factors which is essentially platelets..

  Well again, not to quibble, but there is a sizeable difference. Platelets are irregularly shaped non-nucleated cell fragments. Technically, they're a formed element of blood because they're encapsulated by a membrane. As you probably know, membraned blood components must be ABO typed before transfusion, although platelets are only matched for type compatibility rather than type specificity. Clotting factors are fairly simple, soluable proteins.

  I am curious about how the Army handles blood, if it indeed uses whole blood. As I mentioned before, platelets must be kept moving and warm. Red Blood cells must be refrigerated. Plasma must be frozen. So if you had a bag of whole blood, what would you do with it? Freeze it? Refrigerate it? Or keep it warm and moving back and forth?

  Currently, FWB transfusion donors are prescreened and typed beforehand. They're called upon (Ordered) to donate when they're needed.
• 

  Marvin Shilmer

  -

  The fact is that no JW is ever going to be pressured to accept a whole blood transfusion…

  That depends on where the Witness lives. In developing countries it is not uncommon for doctors to treat patients with whole blood transfusion to save a life. See my post just above for references.

  Marvin Shilmer

  http://marvinshilmer.blogspot.com
• 

  Shawn10538

  OK. so I am learning a lot here. I was reading the wikip[edia article, but no mention there of actual percentages of how often exactly whole blood transfusions are used, and where and why they are used. I guess I should stop saying that whole blood transfusions don't exist. There is enough evidence to prove I was wrong in that. But I also noticed that wikipedia called whole blood, the practice of constructing whole blood from previously fractioned donations. I object to that. That is one area we can really take a stand and say, "Sorry, let's stop calling that whole blood." We should not call that whole blood. A new term must be used there because, it is not whole. It is a manufactured produc withg different percentages of the different blood parts.

  In regards to these prescreened persons who donate their blood. Where does this take place? Do hospitals do this? The Red Cross showed me a room of people who donate regularly. Many of them had special blood types and are these very prescreened individuals. And all of this took place, not at any hospital but at the Red Cross facility in Pamona. That is where all the hospitals in southern California get their blood. no word from them of any hospitals in So Cal that do not get their blood from them or that have their own collection services.

  If there are any hospitals that collect their own blood I'd like to know who and where. Definitely I am sure that no blood donor gets a call in the middle of the night and gets the message, "You must report downtown at the hospital immediately because we have a person bleeding to death." I am quite sure that every hospital has blood on hand for emergencies. I mean, that is ALL hospitals have isn't it? Emergencies. That is what the hospital is for.

  In emergencies, the hospital does not call anybody but their local blood bank, or natiuonal blood bank. That would be the Red Cross in most cases. So hospitals use blood from blood banks. That is what the blood banks are for, just those kind of emergencies. That is why, getting infop from the Red Cross itself is more reliable. If anybody knows about blood it would be them wouldn't it?

  I have much more research to do, but I think I am on a new track here.

  Thanks to all contributors.