New Medical Technology Permits Bloodless Surgery

By Jan Howard

A growing number of people are choosing to receive medical and surgical care without the use of blood or blood products.

A patient’s decision to choose not to receive blood transfusions may be for a number of reasons, including religious conviction, such as with Jehovah’s Witnesses; to avoid possible transfusion reactions; or to minimize the risk of infection from blood-borne illnesses, such as hepatitis and HIV.

To meet the needs of these patients, sophisticated surgical procedures, such as open heart, cesarean sections, mastectomies, joint replacements, and many others, are being performed without blood transfusions through Bridgeport Hospital’s Bloodless Medicine and Surgery Program.

Bridgeport Hospital is one of two hospitals in the state to offer a program that provides transfusion-free medical care for patients who request it. It began offering the program three years ago. Hartford Hospital also offers a bloodless program.

Bridgeport Hospital has a dedicated staff, policies and procedures, and a coordinator that are necessary to offer the program, Program Coordinator Ron Travaglino said recently.

Management of the program is hassle free, he said.

“We do it a lot. This is a service we offer,” Mr Travaglino said. “It is not a case-by-case scenario.”

Through the program, patients electing to have bloodless medical care are matched up with an appropriate physician. “Everyone knows ahead of time that this is bloodless care. It is all smooth running.”

“Ours is a formalized program. All the forms are in place,” he said. Patients must sign appropriate releases to take part in the program.

The program calls for close management of the patient, he said. “We monitor the patient very precisely.”

Medicine is not an exact science, Mr Travaglino said. “The blood supply is safer, but there are still blood-borne diseases that can be contracted, such as hepatitis. The public is more alert and educated today to the potential risks of taking transfusions.”

Patients want to know what their medical options are, he noted. “They want to know if a procedure can be done without blood, without these risks, and have the same outcome.”

There are guidelines for the hospital’s bloodless program, he said. “We explain alternatives that can be used. If there is a risk in avoiding blood, they’re informed.” However, he added, no one can guarantee that a blood transfusion can save a life.

Mr Travaglino said religious reasons and health concerns are addressed. If it appears a blood transfusion may be necessary, the patient can change his/her mind.

He said over 2,000 patients have participated in the bloodless program. “Not one changed their mind,” he said.

He said Bridgeport Hospital’s program has attracted patients from as far away as New York and Massachusetts.

Religious reasons account for the largest number of people participating in the program, he said.

The bloodless program helps relieve pressures on a blood supply system that is severely taxed, Mr Travaglino said. “There is a national blood shortage. We don’t want to use more blood than we have to.”

When such factors as the time needed to collect and process blood and the risk of infection and rejection with blood transfusions are considered, “bloodless [surgery] has a more consistent and positive outcome. The outcomes speak for themselves,” he said.

Modern tools, techniques, and medications make it possible for surgery to be performed transfusion free by reducing blood loss and increasing blood volume, Mr Travaglino explained. They include:

*Laparoscopic, or “keyhole” surgery. This is performed with a small incision, using tiny cameras and surgical tools. Smaller incisions can mean less blood loss.

*Using lasers instead of scalpels. Lasers seal blood vessels as they cut, helping maintain safe blood levels.

*Electrocautery. This device, using electrical current to seal vessels cut during surgery, also helps maintain safe blood levels.

*Argon beam coagulator. This device clots blood at incision sites, reducing bleeding.

*Cell saver. This device collects, filters, and returns to the patient blood that would otherwise be lost during surgery. “This is a recycle of a patient’s own blood,” Mr Travaglino said. “There’s no time delay. It’s the best blood a person can get.” Pre-donation of blood is not needed, he said. Though this procedure is available at the hospital, it is not part of the bloodless program.

*Volume expanders. Intravenous fluids can be given before and during surgery to enhance the patient’s blood. This keeps the blood pressure at a safe level.

*Synthetic erythropoietin. This medication stimulates the production of red blood cells, building up blood levels so the patients can withstand a certain amount of blood loss.

“If the person is anemic, that drug can bring red blood cells to normal or above normal by the time of the surgery. It levels the playing field for a positive outcome,” Mr Travaglino said. Drugs given following surgery can build up what blood was lost, he added.

Mr Travaglino said there are new medicines in different phases of testing with the FDA. Some are totally synthetic, some are human or animal hemoglobin that has been modified, he noted.

 “When approved, they will be a big boon to the bloodless technology. We will see a new approach.”

Mr Travaglino said the hospital has a core group of physicians in medicine and surgery that are dedicated to bloodless technology to meet the needs of patients who request it.

“Patients’ rights are growing,” he said. “They have the right to say they don’t want blood transfusions as part of their treatment. They can choose to accept or not accept blood. If a patient says no blood, we’ll honor that.”

The program has been successful, Mr Travaglino said. “We’ve done some really great stuff here – major cardiac surgeries, total knee and hip replacement, obstetric cases, hysterectomies, and complicated neuro-surgeries. These are all complicated surgeries.”

Internal bleeds have also been handled successfully, he said, adding, “It takes a lot of diagnostic testing to pinpoint the area of bleeding.”

The bloodless program, Mr Travaglino said, “is very exciting.

“There are 150 programs in the world now. There is tremendous growing interest in Europe, Latin America, and Canada.”

The program began in answer to concerns of a religious group, Jehovah’s Witnesses, but it now is of benefit to all patients, Mr Travaglino said.

 In the early 1950s, heart surgery was performed without blood transfusions. In the 1980s, the use of bloodless surgery jumped, he noted. “The time had come to get behind this type of surgery.” 

The outcome has been better patient care for all patients, Mr Travaglino said. “Jehovah’s Witnesses patients helped us to learn more and to apply what we learned for everyone.”

For information about Bridgeport Hospital’s Bloodless Medicine and Surgery Program or to determine whether a specific procedure or specialty is included in bloodless care, contact Ron Travaglino at 203/384-3848.