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When Your Patient Says, “I Don’t Want Blood”

YuschakJamesV[2]By James Yuschak, MD

Every medical institution encounters patients who don’t wish to receive donated blood or primary blood components. Patients making such requests may have religious beliefs that oppose blood transfusions or personal concerns about the potential risks of donated blood.

Most physicians are able to treat these patients, but many doctors worry about the challenges they might face if individual needs or circumstances arise that create difficulties. It’s important for patients and physicians to be comfortable when choosing experts in bloodless and blood conservation procedures.

At the Center for Bloodless Medicine and Surgery of Abington Memorial Hospital, our team of specialists serves the comprehensive needs of patients who request care that avoids the use of blood. As one of the few programs in the region providing bloodless care, our highly experienced staff use advanced medical technology and methods while treating patients in an atmosphere of mutual understanding, trust and respect. We see patients from every specialty, including surgery, oncology, labor and delivery, as well as general medicine.

Having a bloodless medicine team in place before treatment begins is vital for good outcomes. Physicians, surgeons, anesthesiologists, nurses and other healthcare professionals on the Center’s team are familiar with, and prepared to handle, all types of procedures and emergencies. We use well-proven techniques to avoid blood use and minimize blood loss.

Preoperative planning, intraoperative techniques and post-operative plans are key program services. Patients meet with staff at the Center for Bloodless Medicine and Surgery to discuss the risks, benefits and alternatives to blood transfusions. This education and interview session helps each patient understand the options available, including blood conservation choices, and document his or her wishes. Patients receive special wristbands to ensure that their desires are met. Their charts and beds also are marked with stickers and signs to remind staff of blood-related requests.

Patients benefit from a variety of methods that support their choices. For elective surgery, we try to determine hemoglobin and hematocrit levels 21 to 30 days before the scheduled procedure. By doing so, patients who may need additional pre-operative management will receive it and gain more optimal levels. All of our major surgery patients are advised to see a hematologist preoperatively.

Many who come to the Center for Bloodless Medicine and Surgery choose minimally invasive and robotic procedures when appropriate. Minimally invasive and robotic surgery are accepted for their benefits, including reduced blood loss, lower need for transfusions, less pain, shorter recovery time and minimal scarring.

Patients also may choose autologous blood donation preoperatively or have their own blood collected and returned during surgery. Special tools are used to cut and seal blood vessels quickly, minimizing blood loss. Bone-marrow stimulating medicine can be given to trigger the production of red blood cells. The Center for Bloodless Medicine and Surgery also supports reduced blood testing, both in frequency and in the amount drawn. This micro-sampling lessens blood loss and helps prevent anemia.

All patients can benefit from such techniques. Research shows that complications related to blood transfusions—including immunologic concerns, infections and lung injury—all affect patient outcomes. We need to be as judicious in the use of blood and blood components as we are with any other medicine.

Increasingly, physicians are realizing that we don’t need to use blood as aggressively as we have in the past. The idea of blood management is gaining wider acceptance throughout the medical community. We are seeing hemoglobin thresholds for procedures getting lower across the U.S. and practice patterns changing.

At Abington Memorial Hospital, Randall Thomas, our administrative director at the Center for Bloodless Medicine and Surgery, also promotes blood management throughout the institution. Experts speak about bloodless medicine and blood conservation at grand rounds and provide other educational opportunities for physicians and community members to learn about this important and growing area of medical practice.

James Yuschak, MD, is medical director, Center for Bloodless Medicine and Surgery; and director, Trauma Program at Abington Memorial Hospital (www.amh.org).

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