Source: http://www.poughkeepsiejournal.com/saturday/localnews/stories/lo080704s2.shtml (Scan down for highlighted section about JWs)
Saturday, August 7, 2004
Technology conserves bloodBy Elizabeth Lynch
Poughkeepsie Journal
| Kathy McLaughlin/Journal St. Francis Hospital, where this blood is stored for use, is among local hospitals utilizing new procedures and technologies that cause less bleeding. |
Procedures help cut down need
When the American Red Cross asked hospitals to postpone elective surgeries last month because of critically low blood supply, two local hospitals did not comply.
No, they weren't thumbing their nose at the blood shortage.
Rather, both St. Francis Hospital, the regional trauma center in the Town of Poughkeepsie, and Vassar Brothers Medical Center in the City of Poughkeepsie have reduced their reliance on blood from suppliers.
The two hospitals are using technological ad-vances that limit the amount of bleeding during surgery and allow doctors to recycle lost blood. How hospitals conserve blood has become increasingly important at a time when blood supplies have been chronically low, a situation exacerbated during the summer when donations typically drop off.
''We're trying to use blood as a last resort,'' said Terri Bostock, a lab supervisor at St. Francis Hospital.
The New York Blood Center has rationed blood deliveries to hospitals because donations are below what is needed.
Blood supply limited
The organization limited B-negative blood in mid-May. In July, as a result of low donations, the organization was forced to increase its rationing of B-negative blood. It also limited distribution of O-negative and A-negative blood.
On July 15, the American Red Cross asked hospitals to delay non-emergency transfusions for patients with type-O blood. That meant delaying some elective surgeries. The Red Cross' request was rescinded less than a week later when donations increased.
Type O-negative blood is in the greatest demand. Not only does 7 percent of the population have O-negative blood, it is considered the universal donor, because all blood types can receive transfusions of O-negative.
Blood usage has outpaced donations. In June, the American Red Cross New York-Penn Region distributed 27,527 units of blood, but only collected 26,462 units.
The organization predicts hospitals' demand for blood will increase 3.7 percent each of the next four years because of the aging population and the fact doctors are treating more serious illnesses aggressively and successfully.
St. Francis, through its Transfusion Alternatives Center, has reduced its use of blood from the American Red Cross by 32 percent in the first six months of 2004 compared to the same time frame in 2003.
Doctors are asked to justify requests for blood transfusions and alternatives are tried first, Bostock of St. Francis said.
''We are grateful to our hospitals when they do do their best to conserve blood,'' said Dr. John Burch, the American Red Cross' chief medical officer.
Vassar is creating a similar program and has its own donor service, said Greg Bishop, vice president for surgical services.
''We have the ability to go to our own donors when we need specific blood types,'' Bishop said. ''It's a safety valve.
Technology has allowed hospitals to reduce blood loss, Burch said. ''They use laser and all types of cutting that don't cause the extent of blood loss that used to be caused by steel knives,'' he said.
Substitutes available
There also are blood substitutes -- compounds that can be infused into a patient to transport oxygen through the body. These do not need to be matched to a specific blood type, but they only have a lifespan of 24 to 48 hours, compared to three months for a true blood transfusion.
''It will be helpful in the (emergency room) or to stabilize in the field,'' Burch said.
As a result of technological advances, doctors are using laparoscopic and laser procedures that minimize blood loss.
''There's a whole lot less blood loss with (laparoscopic surgery) than with traditional open procedures,'' Bishop said.
Both hospitals also use the harmonic scalpel, which closes off small capillaries as it cuts. Both also use a cell saver, a piece of equipment that recycles blood. It collects spilled blood during surgery, washes it and returns it to the patient.
St. Francis works with patients for weeks before they go into surgery to ensure they are not anemic. Anemic patients are more likely to need a blood transfusion, than those who have taken iron or vitamin B-12 supplements before the procedure, Bostock said.
The hospitals sometimes prescribe drugs designed to boost the ability of bone marrow to produce red blood cells. This often is given to cancer patients on chemotherapy. The drugs used in chemotherapy can kill bone marrow and reduce the body's ability to produce red blood cells.
Doctors are asking patients who need elective surgery to pre-donate their own blood in case they need it.
Both hospitals perform bloodless surgery. Bloodless surgery means the patient doesn't receive a transfusion during the procedure. It does not mean that the patient doesn't bleed.
St. Francis performed its first bloodless surgery on a Jehovah's Witness in 2003. As Christians, Jehovah's Witnesses request non-blood alternatives because they believe the Bible's command to ''keep abstaining from ... blood.''
''It's absolutely the safest thing to do, not just for Jehovah's Witnesses, but for everyone,'' said Dr. Kenneth Hansraj, a spine surgeon affiliated with St. Francis.
Even though transfusions are safe, there is still a small risk associated with them.
Patient donates own blood
Town of Poughkeepsie resident Domenick Diecidue had his lower back reconstructed in 2001. He donated two pints of his own blood before surgery.
''In case I needed it,'' he said. ''I didn't want anybody else's blood because I was afraid of getting an infection.''
Hansraj used the cell saver and was able to reuse about half of the blood Diecidue lost during the procedure.
Only a few months ago another patient, Staatsburg resident Nancy Hoban, lost a ''few teaspoons'' of blood during back surgery. Hansraj used the cell saver, as well as other techniques, to minimize bleeding.
Hoban didn't even donate her own blood before surgery.
''I think it's wonderful,'' Hoban said. ''To get your own blood back, it's just safer and it's not wasting blood that someone else may truly need.''
Bloodless surgery also means the surgeon has a better view of what he is working on.
''When you don't have a lot of blood, you are able to do your work quickly and you are able to see better,'' Hansraj said.
Despite the hospitals' ability to reduce the need for blood, advocates say there always will be a need for blood donations.
''Even though we can come up with all these alternatives, sometimes blood is the only thing that will save someone,'' Bostock said.
Elizabeth Lynch can be reached at [email protected]