Bloodless surgery

The term "bloodless surgery" 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.”^[1][2][3][4] 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”.^[5]

Contemporary usage of "bloodless surgery" refers to both invasive and noninvasive medical techniques and protocols. The term is somewhat confusing.^[6] 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.^[7][8] Champions of bloodless surgery do, however, transfuse products made from allogeneic blood and they also make use of predonated blood for autologous transfusion.^[9] 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.

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Principles of bloodless surgery

Several principles of bloodless surgery have been published.^[10]

Preoperative techniques such as erythropoietin 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.^[11] 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 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 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.^[11]

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 is cost-saving. The cost of blood in the US hovers around $500 a unit, including testing.^[12] 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.[2]

Hospitals and medical centers with bloodless medicine programs

United States

• Legacy Good Samaritan, Portland, Oregon[3]
• Legacy Emanual Hospital, Portland, Oregon[4]
• Legacy Salmon Creek, Vancouver, Washington[5]
• 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
• Sharp Chula Vista Medical Center, San Diego, California
• Atlanta Medical Center, Atlanta, Georgia
• Pennsylvania Hospital, Philadelphia, Pennsylvania
• Baptist Health Inc., Jacksonville, Florida
• Mercy Medical Center, Canton, Ohio
• Jackson Memorial Hospital, Miami, Florida
• Jersey Shore University Medical Center, Neptune, New Jersey
• CHRISTUS St. John Hospital, Nassau Bay, Texas [6]
• Creighton University Medical Center,[7] Omaha, Nebraska
• Crittenton Hospital Medical Center,[8], Rochester, MI

Brazil

• Clinica São Lucas, São Paulo, São Paulo

Directories

• International Directory maintained by Bloodless Healthcare International

References

Further information about bloodless surgery

• Thomas Kickler M.D. on Bloodless Surgery
• Cell Salvage
• Outline of bloodless management techniques
• Bloodless Management Care Guide
• Bloodless surgery helps save lives - Imperial College, London
• noblood.org - A 'virtual community' for healthcare professionals and others who wish to discuss bloodless medicine
• Society for the Advancement of Blood Management
• Jehovah's Witnesses on blood
• Time article on bloodless surgery
• MSNBC article

See also

• Knocking, a documentary on Jehovah's Witnesses that features a bloodless liver transplant