Hello :o)
I just found this posted on the Christianity board of AOL in *Topic Suggestions* and post it below for anyone interested in the matter or for any AOL member who might wish to respond on that board. No source was indicated, but the unusaul spacing in parts of the original posting which I have sought to rectify here, would imply an organisational CD or publication.
Subject: Re: Bloodless Operations
Date: 09/07/2002 23:09 GMT Standard Time
From: [email protected]
>Just heard on the news that Derriford Hospital in Plymouth have been pioneering a 'use you own blood' proceedure in thier theatres. While your operation is in progress, a machine cleans your blood and returns it to your body, thus ending the need for using other people's blood. Its not suitable for everyone apparently, but it does reduce the chance of infection and speeds up recovery.
>
>Would this be of some use to JWs?
This technology has been around for some years and many Jehovah's Witnesses make use of machines such as these during surgery. The technology is not only useful for Jehovah's Witnesses though. Many people prefer not to be transfused with blood these days.
The World Health Organisation reported recently that there are 5,000,000 Hepatitis C virus infections each year as a result of Transfusion and Injection practices.
As a result of fear of litigation the medical profession are trying to improve the safety of blood transfusion which has resulted in the cost of a unit of blood almost doubling to 142 Euros.
Added to this has been the cost of compensation to those whose tainted blood transfusion has resulted in major complications resulting in on-going health problems, together with compensation paid out to surviving family members where death of the patient has occurred.
Major Operations are being carried out throughout the world without blood. There was a case study on a 10 month old girl with a congenital heart defect where the surgery was completed with virtually no blood loss resulting in no transfusion being performed where the heart was stopped for just 26 minutes during the procedure.
Liver surgery has always traditionally been an operation where there has been severe blood loss and requiring large transfusions of blood. However, using modern methods the cancerous portion of the liver of an elderly man in Germany was performed recently using no blood whatsoever.
Another operation where there has in the past been high blood loss is knee replacement. However, new techniques of surgery now mean that these operations can be carried out much more safely and successfully without resorting to blood transfusion at all.
A 4yr old girl in Italy had serious heart defects and required a series of operations, one of these operations was performed with only 100 ml of blood loss and all were carried out without any transfusions of blood.
Another patient, aged 62 years, had a hip revision, a procedure usually involving greater amounts of transfused blood. He had a total blood loss of 200 ml plus 50 ml post operatively using modern techniques, compared with a patient in the same hospital using standard methods who was transfused with 20 units of blood for the same operation.
In Leeds St James University Hospital has found that it has had a 70% cost reduction in blood supplies since implementing new techniques. It has carried out numerous operations without using blood. Recently a 19 year old from South Africa flew to Leeds to have a liver transplant performed without blood and was able to fly home again 4 weeks later.
The medical journal "Clinical Transplantation" documents the case of a 23 year old man with acute liver failure, needing a liver transplant. The average number of units for the type of operation he needed is 43 units, although up to 300 units have been used. By the time he was admitted to hospital he had suffered severe internal bleeding for some time and was in a coma. The medical team that was chosen was able to perform the procedure with a blood loss of two cupfuls, with no blood transfusion. 7 days after the operation he was taken from intensive care to a general ward where he was discharge 11 days later. Within 6 months his blood count was back to normal.
The recent world wide Sanguis study has shown that many transfusions have been performed unnecessarily exposing patients to nonessential risk. Some hospitals and surgical teams transfuse routinely in hugely larger quantities than others for the same operations. Those who transfused less were able to perform these procedures cheaper, patients had a lower mortality rate and were discharged from hospital earlier with lessened post-operative complications.
One problem is that of ignorance and failure of medical staff to keep up to date with new information because of the pressure of their working conditions. We are aware personally of a 3 year old with a large tumour of the bowel where doctors were pressurising the parents to consider blood transfusion. When told of the number of drugs plus devices and techniques to reduce blood loss and maximise the body's ability to transport oxygen cells
available, the consultant had to admit that he had little knowledge and no experience of them.
Until recently no clinical trials were conducted on blood transfusion to determine accurately the level of haemoglobin at which transfusion should take place. It has been in the past an arbitrary decision of the surgical team involved. It is now recognised that patients can tolerate much lower haemoglobin levels than previously thought provided that fluid volume is compensated for. Some hospitals have changed their blood transfusion trigger from 10 g/dl to 8 g/dl and have found that they have been able to halve the number of units transfused. At Mount Sinai hospital a male patient made a successful recovery from 1.7 g/dl without transfusion. It has also recently been discovered that stored units of blood are subject to bacterial contamination and viral infections which can have severe effects on the patient who is already in a weakened physical condition. Blood is a living organism and yet it is stored in refrigeration units, unfrozen, for up to 6 weeks. Added to this it has also been found that blood transfusion greatly suppresses the Immune System and when given to cancer patients can dramatically increase the risk of further cancer and tumours. In other patients it increases the chance of primary cancer and tumours and other infections overwhelming the body. Some studies indicated that cancer patients who are transfused have a 50% increased chance of death during recovery. The American Journal of Medicine estimated that there are 215 deaths every year for cancer patients caused by post operative infection due to immune suppression from blood transfusion.
The Canadian Journal of Surgery 1988 reported that in patients with rectal cancer the 10 year survival rate was 82% with no blood transfusion, 53% for those who received 1 - 5 units of blood, 31% for those with 6 - 10 units and 14% for those who had been given more than 10 units.
Blood transfusion also carried with it the risk of human error, the wrong blood type being transfused which accounts for half of the deaths attributable to blood transfusion. Studies have shown that the more units of blood are transfused the greater number of post operative complications occurred and patients needed to stay in hospital for more days. TRICC study showed that patients who were transfused in liberal amounts had a much higher mortality rate than those who were given restrictive amounts and those that did best were those who were given no blood at all. Therefore blood transfusion does not reduce morbidity and mortality but would appear to actually increase it. In Australia surveys have indicated that 96% of the population there would rather not have blood if there was a choice, however only 4% of those were aware of the alternatives available.
A much safer treatment is to stimulate red-cell production in the patient by administering Erithmopoetin (EPO), so that the body can compensate for severe blood loss itself.
Improved surgical methods, for example electro-cautery devices, glue pads and meticulous surgery can minimise blood loss. It is now quite usual and normal practice to use blood salvage techniques during surgery resulting in up to 50% of blood loss during surgery to be reintroduced into the patient.
Good doctors want to respect patients own views and decisions and to do what is best for the patient bearing in mind their personal choices. Most now recognise that the patients mental well-being has a marked effect on their recovery. In Canada a 15 yr old girl with Leukemia made it quite clear that she did not want treatment involving blood transfusion. Despite her maturity and informed decision the hospital obtained a court decision to give her a blood transfusion and strapped her down on the bed whilst she screamed and struggled and forced blood on her. She subsequently died. This is surely barbaric and tantamount to rape. (Is this Shunned Father's daughter? :o( ) The United Nations recognise that people have the right to make informed decisions on what is done to his or her own body. The UN declaration of human rights and biomedicine, article 5 states that an intervention may only be carried out after the person concerned has given free and informed consent to it. Article 6 states that the opinion of the minor should be taken into consideration in proportion to age and maturity.
If an individual doctor feels inadequate or underqualified to perform procedures without blood transfusion they should refer the patient to doctors who have the knowledge and experience to perform these modern techniques.
Whilst in Australia we visited the Kaleeya hospital in Fremantle, near Perth and spent the day with the Coordinator of the Blood Conservation Programme there, together with one of the anaesthetists, who is not one of Jehovah's Witnesses but who regards non-blood surgery as the gold standard to which all doctors should aim, regardless of the religious beliefs of the patient concerned.
He made the point that 300 years before it was generally accepted there were scientific indications that the universe is expanding. Strongly entrenched beliefs that the universe is static prevented that truth from being accepted. A similar thing has happened with blood transfusion.
For 2,500 years blood letting was the norm. Whether the patient had broken bones or bleeding blood letting was the treatment. There was no scientific evidence of benefit but they believed in it and so performed it.
In 1667 the first transfusion of animal blood into a human being was performed in an attempt to cure mental illness. The patient died and blood transfusion was banned for 150 years.
In 1818 James Blundell, of London, performed the first human blood transfusion, the patient died. He continued to transfuse blood and 50% of his patients died.
In 1901Kal Landsteiner discovered that humans had different blood groups, for 20 years doctors refused to accept this discovery and ridiculed the idea.
In 1915 Richard Lewisohn discovered an anticoagulent and found that this improved the ability to store and transfuse blood. It was not until WWII that blood became an accepted method of treatment, and not really until 1945 that it was used on the civilian population.
In 1957 Denton Cooley found that by performing bloodless heart surgery patients did better and that transfusion complications were avoided. For 40 years prejudice has prevented the acceptance of this fact and doctors routinely give unnecessary blood transfusions.
In 1970's Dr Ron Lapin and anesthesiologist Fred Garcia established the Institite of Bloodless Medicine and Surgery in California, by 1986 they were able to report their experience with several thousand patients who had undergone major surgery without the use of blood, including general, brain, heart, chest, vascular, cancer, urinary tract, gynaecology and orthopedic surgery. Emergency operations had also been carried out successfully on patients who had haemorrhaged and lost up to 90% of their blood volume. They reported that their patients did as well, or in many cases better than patients who had blood transfusions. The mortality rate and incidence of morbidity was less than in conventional surgery.
In 1987 Dr Richard Walker writing in the American Journal of Clinical Pathology reported that about 20% of all transfusions resulted in some type of adverse effect.
In 1990 Dr Charles Higgins, Director of Transfusion Services in the Massachusetts General Hospital was quoted in the Boston Globe magazine as saying that blood is the most dangerous substance we use in medicine.
The hospital that we visited spoke about two particular cases where accidental injury had resulted in patients having a hemoglobin reading of 4 g/dl where surgery was successfully performed without blood and the patients went on to make excellent recovery within 2 weeks. The normal count for a man is between 14-18 and for a woman between 12 and 16.
There are wide discrepancies in the practice of transfusing blood. For example for hip replacement operations in the U.K. some hospitals have a 98% rate of transfusion, others have a 25% rate.
Most doctors will now agree to avoid all allogenic blood on adults, this means that they will agree to not transfuse blood, it does not mean that they are skilled or proficient in employing other methods of treatment. If I decide that I want my bedroom furnished using only natural fabrics and I go to a company that normally supplies man made fabrics and they agree to decorate my room without using these fabrics, they may do so but without curtains, without carpets, without bed-coverings, and the result is not going to be very favourable. They need to be honest and say that they have no ability to provided natural fabrics and refer me to a company that specialises in the fabrics that I require. The same is true of surgery. Patients that request non-blood surgery need to go to doctors who have the modern training and experience in that kind of surgery, otherwise doctors who are used only to surgical techniques where blood transfusion is normally required are not going to be able to carry out these procedures successfully without blood.
Before performing surgery a doctor must prepare his patient by maximising blood production with Iron and EPO. No car driver would set off on a long desert journey without first having a mechanic check out his car and filling up with fuel and water. Iron can be likened to fuel for the body's blood levels and EPO can be likened to an accelerator. You would choose a mechanic who is familiar with the car engine that you have and understands modern engines. Likewise we need doctors who are up-to-date with modern methods of minimising blood loss and blood salvage and understand what actions should be taken in an emergency without using blood. Before surgery it is possible to use haemodilution, taking out blood, diluting the blood in the body so that blood lost contains less red cells, and reintroducing the patient's own blood after surgery. Much blood can be saved by using microsampling for blood tests, it is quite possible to use 1 ml of blood rather than the normal 5 - 10 ml per test previously used which can enable the patient needing multiple tests to retain more of his/her own blood.
There are many diseases that can be carried in donated blood. AIDS, CJD, VCJD, Hepatitis Cytomeglavirus, Epstein-Barr, Prion Diseaseas, T-T Virus, Malaria, Toxoplasmosis, Typhus, Babesiosis, Borrelia, Filiariasis, Syphilis, Bartonella, Brucella, Salmonellosis, Typhoid etc. In 1975 it was reported that there were 17,000 cases of hepatitis B alone resulting from blood transfusions, with an average of 3,500 deaths per year. A report published in 1998 showed that there were 4 million people in USA along suffering from hepatitis C with 8 - 10,000 deaths per year. In 1993 a study published in the American Journal of Reproductive Medicine estimated that 250,000 women had contracted hepatitis C after being transfused following cesarean sections. Another report in 1995 showed that 20,000 Americans had contracted AIDS from blood transfusion. In Germany in 1993 it was found that a blood supply company had taken short cuts in screening and batches of contaminated blood had been shipped to 86 hospitals including the UK. At the same time a Bombay hospital reported that between 1992 and 1994 1,200 had been infected with HIV and 60,000 with hepatitis C. "Although many measures have been taken to reduce the risks of blood transfusions and although sophisticated technology will continue to improve its safety, it is not possible to provide a blood supply with zero risk." Practice parameter for the use of red blood cell transfusion - 1998. It has been estimated that the risk of contracting a serious or fatal transfusion transmitted disease is about 3 in every 10,000 units. The mortality rate is estimated at between 29 and 103 per million units. That seems small until you realise that there are 11- 12 million units transfused each year in the USA alone. In the UK the most obvious threat is
CJD. In Australia no-one who has lived in the United Kingdom for last 10 years can be blood donor. Far more people are dying as a direct result of blood transfusion than have died from refusing one. In July 1999 the medical journal Transfusion showed that there was 35% greater risk of serious bacterial infection and a 52% greater risk of pneumonia associated with blood transfusion. Additionally 28.8% died as a result of these infections.
To sum up - the benefits of bloodless surgery are that your avoid the potential risks of contracting disease. You avoid a host of transfusion reactions and possible complications. You enhance your chances of quicker recovery after an operation. You generally can expect to spend fewer bed days in hospital with lower hospital and medical costs. If you have surgery for cancer chances for your long-term survival are likely to be improved. You reduce the risk of getting an infection after an operation and are thereby less like to need antibiotic therapy with its attendant risks and complications.
For those who would like more information John Wilson Booksales in Princes Risborough distribute a book called Your Body, Your Choice. Tel: 01844 275927 Fax: 01844 274402. The book gives frank information about the dangers and risks of blood transfusions and outlines the many alternatives that there are available to us today.
Andrea
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