The advent of ‘bloodless drugs’ is helping some patients avoid blood transfusions

The introduction of 'Bloodless Drugs' is helping some patients avoid blood transfusions

Before Andrea Acerra, 45, had a hysterectomy due to heavy menstrual bleeding in November, she was given iron to increase her red blood cell count and avoid blood transfusions.

“I was just worried about the side effects of the iron, but there were no side effects,” says Acerra, a senior medical assistant in Bay Shore, NY.

South Shore University Hospital in the Bay Shore, where Acerra was treated, offers bloodless medication as an option. The program screens people to see if they are candidates for bloodlessness surgery. So far, the surgeons there have performed various procedures using non-blood-transfusion medical techniques.

Also known as patient blood management, it is used when a blood transfusion not an option for religious reasons or safety concerns. This concept was created by the community of Jehovah’s Witnesses who believe that it is against God’s will to receive blood from others. There are over 8.6 million Jehovah’s Witnesses worldwide.

Bloodless drugs became more widely used in the 1980s due to concerns that donated blood could be contaminated with HIV and hepatitis C. This is no longer a concern because Blood Donation in the United States are screened for these infectious diseases along with several others.

However, “there is a substantial portion of the population that cannot or will not receive a blood transfusion,” said Dr. Aaron Harrisonassociate medical director and gastroenterologist at the South Shore.

And thanks to bloodless medical techniques, many of them won’t have to, he added.

The choice of bloodless medication becomes even more important during a pandemic as the supply of donated blood dries up, causing shortages across the country. “We don’t have blood on hand so if we can get away without blood and do things safely that would be ideal,” says Harrison.

At the South Shore, patients like Acerra are identified before surgery, and if they are found to be anemic or unable or unwilling to receive a blood transfusion, they are given a blood-saving or blood-boosting regimen.

“We instructed our doctors to bring up the topic that we could increase the blood count before surgery, to minimize blood loss and the need for blood transfusions,” says Harrison.

“It’s interesting, because I don’t think anyone else around the country has a pre-screening process,” added Dr. John Davissurgical director at the South Shore.

The hospital has worked closely with the local community of Jehovah’s Witnesses, he said, so the new program is a natural offshoot.

In addition to the use of iron and the hormone erythropoietin (EPO), said bone marrow to do more red blood cellsThere are other ways to reduce the risk of having a blood transfusion before surgery.

For starters, “we can reduce the number of pre-procedure blood tests and use smaller tubes to draw blood,” Davis explains.

Another way to reduce the chances of someone needing a blood transfusion is to stop using blood thinners before surgery so they don’t bleed a lot, she said. Dr. Steven FrankMedical director of the surgery and bloodless medicine program at Johns Hopkins Hospital in Baltimore.

It is important to stop taking certain herbal medicines, vitamin E and non-steroidal anti-inflammatory drugs (NSAIDs), as they can increase the risk of bleeding during the procedure.

“Keeping people warm during surgery is also helpful, because even mild hypothermia increases bleeding during surgery, and keeping blood pressure lower can reduce bleeding,” says Frank.

A drug called tranexamic acid may be given to control bleeding, he said.

And then there’s a technology that collects the blood you lose, washes it, and puts it back in during surgery. “This is considered the heart of blood conservation,” says Frank.

“The advent of robotic surgery has also reduced the risk of blood loss during surgery,” he said. “Yes, robotic surgery involves smaller incisions than open surgery, but the main difference is less bleeding and less blood transfusion,” says Frank. “It’s like night and day.”

Blood transfusions can save lives, but they also carry risks.

Davis said donated blood is not ideal. “The blood is old and the number of cells in any effective and oxygen-carrying unit is a small fraction of the total.”

People can also have an allergic reaction to blood, says Frank. “It’s well known and proven that storing blood for transfusion can put you at risk for nosocomial infections, because it suppresses your immune system,” he said.

Transfusion-associated acute lung injury (TRALI), transfusion-related circulatory overload (TACO), and transfusion-related immunomodulation (ABT) (TRIM) are all risks associated with transfusion. . Frank said TACO and TRALI are lung-related complications that are the leading cause of blood transfusion-related deaths.

“People forget about TRALI, TACO and TRIM, which are much more common than HIV or hepatitis C from blood transfusions,” he said. “Your chance of getting HIV or hepatitis C from a blood transfusion like being struck by lightning—about 1 in 2 million.”

Frank said the bloodless drug is becoming more popular thanks to its list of potential benefits. “We all benefited from what we learned from the community of Jehovah’s Witnesses,” he says. “With the right planning, with the right people and technique, virtually any surgery can be done without blood transfusion.”

More information:
The Association for the Advancement of Blood Management has more about medicine without blood.

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