Bloodless Surgery in Medicine
When Richard Lower an English physician completed his successful blood transfusion experiment in the mid-1660s, little did he know about how important this contribution would be to medicine.Today about 112.5 million blood donations collected globally showing how popular blood transfusion is today. While transfusions are still a common practise, would you agree that this trend is on a decline ?
More people appreciate the use of Bloodless Surgery in medicine. No wonder it is performed at an increasing number of medical centers around the world. Are you aware of this option in the field of medicine? What is fuss on this blood management all about? This article discusses why many prefer to avoid transfusion, strategies used to conserve blood and success reports after bloodless surgery.
What Bloodless Surgery Is
Bloodless surgery simply is the avoidance of the use of transfused blood. Today this simple definition has expanded to include changed attitudes toward blood conservation and well new technologies used to minimize the need for transfusions during surgery.
Why Bloodless Surgery ?
Interestingly the issue of bloodless surgery and medicine arose over time as a result of multiple factors.
Religion and ethics
I know you may have heard this before…..One of the earliest motivations for bloodless surgery was to find ways to treat Jehovah’s Witnesses who needed emergency surgery without offending their beliefs about blood transfusion.
They believe that God forbids eating animal “flesh with its blood”.They also abide by what Apostles said asking their first converts to “abstain from blood” as well as from other forms of immorality recorded in the bible.
Their proposed alternative included patient blood management and a collection of medical practices and surgical techniques to help doctors minimize blood loss and avoid transfusions. This really proved to be an eye opener for so many and paved way for what was to come.
However, another rising reason concerns general ethics which is respect for patients’ rights. Today although majority of bloodless surgical procedures are still requested by Jehovah’s Witnesses, there are other patients that would prefer bloodless surgery if given the choice.
This reflects changing attitudes on the part of patients. Gone is the era of “doctor knows best” as more people want to be involved when it comes to choices about their health.To cater for this increase, numbers of medical centers in the United States that offer bloodless surgery are increasing.
Safety of blood
These days many people are forced to ask “ How safe is this blood ?” These fears are related to the quality of blood supply as well as the process of blood transfusion itself.
People are afraid of contracting bloodborne diseases like HIV and Hepatitis from donated blood. Also there is no way to screen potential blood donors for four diseases caused by parasites like malaria, babesiosis, Chagas’ disease, and Lyme disease.
So there might be no way to reassure patients who are concerned about the possibility of being infected by disease agents during a transfusion not even to think about the possibility of transfusion related medical errors due to misidentification of type-and-cross match samples, laboratory errors, or misidentification of the patient ! In some transfused blood had caused allergic or immune system reactions.
Bloodless Surgery Today
Bloodless surgery today include a variety of changes in the practice of medicine itself. How the patient is assessed, evaluated and diagnosed as well as equipment and technological innovations focus on all ways too conserve blood loss.
Evaluating the Patient
Preparation for bloodless surgery is extensive. In most hospitals, anyone who wants to register for bloodless surgery might need to have an appointment with the physician who would review the patient’s request for bloodless care. After a successful review, the patient’s blood might be tested to determine hemoglobin levels and confirm other blood values.
Even during these tests,care is taken to minimize the number and size of blood samples drawn. Microanalyzers are used to run these blood tests such that smaller samples are collected even for multiple tests.
Prepping the patient
To prepare the patient most times, the oxygen-carrying capacity of the patient’s blood is boosted. Patients are given erythropoetin, or EPO to stimulate the bone marrow to produce more red blood cells,as many as seven times the normal amount, several weeks before surgery.
The greater number of red cells increases the blood’s ability to carry oxygen. In addition, patients are given iron supplements, most commonly ferrous sulfate,iron dextran, or vitamin B.
To achieve the aim of bloodless surgery, different methods are employed.Some of these involve the use of some techniques to minimise bloodloss during surgery. These techniques are enhanced by the instruments and machines used .
Sometimes lengthy surgical procedures are not done at once. Although this would mean additional exposure to general anesthesia, it helps reduce the need for a transfusion. The patient can be discharged after the first operation relatively quickly and build up his or her hemoglobin levels before the second procedure.
Some of the techniques employed to ensure bloodless surgery include
Hemodilution : Here the whole blood from the patient is withdrawn before surgery for temporary storage and replaced with a colloid solutions that restores the normal fluid volume of the blood without adding new blood cells. The patient thus loses fewer red blood cells during surgery. At the close of the operation the patient’s own blood is reinfused, thus minimizing the possibility of transfusion error or a transfusion reaction.
Blood salvage involves an automated recovery system that collects the patient’s blood during surgery in a cell separation device. This device separates the red blood cells from other blood components, washes them, and concentrates them for reinfusion. This though has limitations in patients with malignant tumors or active infections.
Another procedure used sometimes is hypotension. Here the arterial blood of the patient is lowered during the procedure. This has been shown to reduce blood loss and the consequent need for transfusions. It also shortens the length of time spent in the operating room. The limitation of hypotension is that it cannot be used in surgical procedures requiring tissue grafting or in patients with coronary artery disease.
The invention of several types of new instruments has allowed surgeons to perform a variety of procedures with minimal blood loss. Miniaturized endoscopes make it possible to perform surgery on the abdomen and spine through very small incisions, often shorter than 1 in (2.5 cm) in length.
Other inventions like of electrocautery devices and harmonic scalpels use a combination of ultrasound vibration and friction to clot blood at the same time as cutting. These reduce blood loss
Pharmacologic agents are also used to reduce blood loss during bloodless surgery. For example aminocaproic acid (Amicar) and desmopressin (DDAVP), which is thought to increase the levels of factor VIII in blood and increase von Willebrand’s factor expression, helping to promote necessary clotting.
Any Successes with bloodless surgery ?
Reports showing experience from patients who have been treated in bloodless surgery show that they are generally satisfied with the care they receive. Physicians also agree that bloodless medicine has beeen a success. They realise that patients recover faster with fewer complications; several centers have reported that patients requiring inpatient procedures leave the hospital on average a full day earlier than patients who have had conventional transfusions.
Proponents of bloodless medicine hope that transfusions will one day be a thing of the past. They say that bloodless surgery represents the future of medicine that is less expensive and safer than medicine with transfusions, which has been the standard practice for decades.
What do you think? Would you prefer bloodless surgery? You decide…