Bloodless surgery

Bloodless surgery is a term that was popularized at the beginning of the 20th Century by the practice of an internationally famous orthopedic surgeon, Dr. Adolf Lorenz who was known as “the bloodless surgeon of Vienna.” [New York Times Oct 26, 1902 p 7] [New York Times Sep 10, 1906 p 1] [New York Times Dec 25, 1902 p 3] [New York Times Nov 22, 1926 p 3] This expression reflected Dr. Lorenz’s methods for treating patients with noninvasive techniques. His medical practice was a consequence of his severe allergy to carbolic acid routinely used in operating rooms of the era. His condition forced him to become a “dry surgeon”. [Jackson et al, Baylor University Medical Center Proceedings, January 2004; 17(1): 3–7]

Contemporary usage of "bloodless surgery" refers to both invasive and noninvasive medical techniques and protocols. The term is somewhat confusing. [Farmer S, Webb D, Your Body Your Choice The layman’s complete guide to bloodless medicine and surgery, 2000 pgs. Preface, 11, 16 ] The expression does not mean "surgery that makes no use of blood or blood transfusion". Rather, it refers to surgery performed without transfusion of allogeneic blood. [Farmer S, Webb D, Your Body Your Choice The layman’s complete guide to bloodless medicine and surgery, 2000 pgs. 11, 14, 75] [Dailey, John F, Dailey’s Notes on Blood Fourth Edition, 2002 pg. 198] Champions of bloodless surgery do, however, transfuse "products" made from allogeneic blood and they also make use of "predonated blood for autologous transfusion". [Farmer S, Webb D, Your Body Your Choice The layman’s complete guide to bloodless medicine and surgery, 2000 pgs. 144-5] The last twenty years have witnessed a surge of interest in bloodless surgery, for a variety of reasons. Jehovah's Witnesses reject blood transfusions on religious grounds; others may be concerned about bloodborne diseases, such as hepatitis and AIDS.

Principles of bloodless surgery

Several principles of bloodless surgery have been published. [Goher et al, Ann R Coll Surg Engl 2005; 87: 3–14]

Preoperative techniques such as erythropoietin (EPO) or iron administration are designed to stimulate the patient's own erythropoiesis.

In surgery, control of bleeding is achieved with the use of laser or sonic scalpels, minimally invasive surgical techniques, electrocautery, low central venous pressure anesthesia (for select cases), or suture ligation of vessels.cite journal |last=Magner |first=David |authorlink= |coauthors=Ouellette, James R.; Lee, Joseph R.; Colquhoun, Steven; Lo, Simon; Nissen, Nicholas N. |year=2006 |month=May |title=Pancreaticoduodenectomy after neoadjuvant therapy in a Jehovah's witness with locally advanced pancreatic cancer: case report and approach to avoid transfusion. |journal=The American surgeon |volume=72 |issue=5 |pages=435–437 |id= [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=Abstract&list_uids=16719200 PMID 16719200] ] Other methods include the use of blood substitutes, which at present do not carry oxygen but expand the volume of the blood to prevent shock. Blood substitutes which do carry oxygen, such as PolyHeme, are also under development. Many doctors view [http://www.harvesttech.com/ANH.htm acute normovolemic hemodilution] , a form of storage of a patient's own blood, as a pillar of "bloodless surgery" but the technique is not an option for patients who refuse autologous blood transfusions.

The [http://www.haemonetics.com/site/content/products/cellsaver.asp?section=hospitals&subSection=hospitals Cell Saver] is a device which recycles and cleans blood from a patient during an operation and redirects it into the patient's body, a technique called intraoperative blood salvage or cell salvage.

Postoperatively, surgeons seek to minimize further blood loss by continuing administration of medications to augment blood cell mass and minimizing the number of blood draws and the quantity of blood drawn for testing, for example by using pediatric blood tubes for adult patients.

Benefits

Bloodless medicine appeals to many doctors because it carries low risk of post-operative infection when compared with procedures requiring blood transfusion. Additionally, it may be economically beneficial in some countries. For example, the cost of blood in the US hovers around $500 a unit, including testing. [Time Magazine, Bloodless Surgery, by John Langone, October 1997; page 5 [http://www.time.com/time/reports/heroes/bloodless.html] ] These costs are further increased as, according to Jan Hoffman (an administrator for the blood conservation program at Geisinger Medical Center in Danville, Pennsylvania), hospitals must pick up the tab for the first three units of blood infused per patient per calendar year. By contrast, hospitals may be reimbursed for drugs that boost a patient's red blood cell count, a treatment approach often used before and after surgery to reduce the need for a blood transfusion. Geisinger Medical Center began a blood conservation program in 2005 and reported a recorded savings of $273,000 in its first six months of operation. [http://www.bizjournals.com/pittsburgh/stories/2006/03/27/story8.html?page=2]

Hospitals and medical centers with bloodless medicine programs

United States

*Legacy Good Samaritan, Portland, Oregon [http://www.legacyhealth.org/]
*Legacy Emanual Hospital, Portland, Oregon [http://www.legacyhealth.org/]
*Legacy Salmon Creek, Vancouver, Washington [http://www.legacyhealth.org/]
* [http://www.swedish.org/body.cfm?id=133 Swedish Medical Center] , Seattle, Washington
*The University Hospital, Newark, New Jersey
*Englewood Hospital and Medical Center, Englewood, New Jersey
*Meriter Hospital, Madison, Wisconsin
*Community Hospital of Los Gatos, Los Gatos, California
*Franklin Square Hospital Center, Baltimore, Maryland
* [http://www.sharp.com/hospital/index.cfm?id=422 Sharp Chula Vista Medical Center] , San Diego, California
*Atlanta Medical Center, Atlanta, Georgia
*Pennsylvania Hospital, Philadelphia, Pennsylvania
* [http://community.e-baptisthealth.com/services/noblood/index.html Baptist Health Inc.] , Jacksonville, Florida
* [http://www.cantonmercy.com/mercyweb.php?pg=bloodless_surgery.htm Mercy Medical Center] , Canton, Ohio
* [http://www.um-jmh.org/body.cfm?id=149 Jackson Memorial Hospital] , Miami, Florida
* [http://www.meridianhealth.com/jsmc.cfm/Services/BloodlessSurgery/index.cfm Jersey Shore University Medical Center] , Neptune, New Jersey
*CHRISTUS St. John Hospital, Nassau Bay, Texas [http://www.christusstjohn.org/ser_blood_conservation.htm]
*Creighton University Medical Center, [http://www.creightonhospital.com] Omaha, Nebraska
*Crittenton Hospital Medical Center, [http://www.crittenton.com] , Rochester, MI
*Kadlec Medical Center, Richland, Washington

Brazil

*Clinica São Lucas, São Paulo, São Paulo

Directories

* [http://www.noblood.org/hospitals.php International Directory maintained by Bloodless Healthcare International]

References

Further information about bloodless surgery

* [http://www.bloodless.com/BL/FAQsPage.aspx?Category=4 Thomas Kickler M.D. on Bloodless Surgery]
* [http://www.osmt.org/cell%20salvage.htm Cell Salvage]
* [http://www.pennhealth.com/bloodless/management.html#top Outline of bloodless management techniques]
* [http://www.pennhealth.com/health_info/bloodless/index.html Bloodless Management Care Guide]
* [http://www.imperial.ac.uk/P3731.htm Bloodless surgery helps save lives - Imperial College, London]
* [http://www.noblood.org/ noblood.org - A 'virtual community' for healthcare professionals and others who wish to discuss bloodless medicine]
* [http://www.sabm.org/ Society for the Advancement of Blood Management]
* [http://watchtower.org/e/medical_care_and_blood.htm Jehovah's Witnesses on blood]
* [http://www.time.com/time/reports/heroes/bloodless.html Time article on bloodless surgery]
* [http://www.msnbc.msn.com/id/12466831/ MSNBC article]

ee also

*"Knocking", a documentary on Jehovah's Witnesses that features a bloodless liver transplant
*Autotransfusion, - the process of returning to a patient their own blood that has been lost.