What is transfusion alternatives

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What is Transfusion Alternatives
Blood transfusion is a familiar term to many, but many people may be unfamiliar with the term transfusion alternatives.
The definition of transfusion alternatives is - not to use others blood or blood products, but rather to use various types of drugs, anesthesia, and surgical techniques/instruments to provide quality treatment to patients. Since World War I, transfusion treatment has been recognized as the standard therapy for modern day medicine. On the other hand, transfusion alternatives came to attention since 1980 to those refusing blood transfusion for medical and religious reasons. In the past, transfusion alternatives was considered to be specialized treatment for people refusing a blood transfusion. However with the development of medicine, the many serious side effects of a blood transfusion are being understood. As a result, transfusion alternatives came to attention in the medical field. In addition, in many other countries, including Korea, that suffer shortages of safe blood supplies have played a role in transfusion alternative development.

Here are three key points regarding transfusion alternatives:
1. Experienced health care professionals respect the choice of the individual patient, and will perform nonblood treatment.
2. As many techniques, equipment, and drugs that are available are implemented and applied during treatment.
3.Transfusion alternatives provide results that will satisfy both patients and health care professionals.

Therefore, modern day state-of-art medical techniques will be used. Examples of these include:
- Thorough preparation prior to surgery. (anemia management, customized surgery, etc.)
- Performing rapid surgery with meticulous hemostasis resulting in minimal blood loss.s
- If a lot of bleeding is expected during surgery, Hemodilution/Blood Cell Salvage/Induced Hypotension can be administered.
- For cases as severe anemia or anemia accompanied by heart disease, hyperbaric oxygen therapy can also be used.
- When there is a lot of bleeding, it is handled with local/systemic hemostatic agents and with appropriate fluids.
- After surgery, avoid needless withdrawal of blood, and control bleeding with continuous, close surveillance.
- In emergency situations that require surgery, medical personnel will respond quickly. (Such as a 24 hour on-call system, and a transfer to a major center)

There are people who require a treatment that is much safer and more effective than a blood transfusion!

By every standard medical and logical, Henry Jackson, lying unconscious in a New Jersey hospital on his 32nd birthday, was finished. Massive internal hemorrhaging had drained him of 90% of his blood. His level of hemoglobin had plummeted from a normal reading of 13 to an ominous 1.7, a number that one of his doctors characterized as "incompatible with survival." Jackson, who refused transfusion because of his religious beliefs was finally transferred to nearby Englewood Hospital to receive treatment without transfusion.

When Jackson was wheeled into the institute, Dr. Aryeh Shander, chief of anesthesiology and critical-care medicine, and his team moved swiftly. First, they essentially paralyzed the patient with drugs to reduce the demand for oxygen by his muscles, brain, lungs and other organs. Next, they gave him high-potency formulations of iron supplements and vitamins, plus "industrial doses" of a blood-building drug, synthetic erythropoietin, that stimulates the bone marrow to produce red blood cells. Finally, intravenous fluids were administered to goad what little circulation he had left.

Breathing on a ventilator, and without a drop of transfused blood flowing in his veins, Jackson gradually began to respond to the treatment. Within four days his blood count had risen significantly. Soon after, he was shaking his head in disbelief and telling his doctors, "If it wasn't for this, I wouldn't be here."
– TIME, 1997

A 71 year old woman, who was admitted to Seoul University Hospital as a patient was, a doctor by profession. In her dismay, she was diagnosed with pancreatic cancer by the internal medicine department and she had to undergo major surgery. She well knew about side effects of blood transfusions, therefore she requested surgery without the use of blood. Usually this kind of major surgery (‘whipple surgery’) requires 2-4 units of blood to be transfused into the patient. The non-transfusion surgical team operated for over 13 hours performing resection of the tumor in the pancreas and surrounding stomach, gallbladder, duodenal and other parts of the small intestines. During the operation, 1500 ml of blood was lost, though preoperative hemoglobin was 11.6 and then dropped to 8.0 immediately after surgery, at the patient’s request, no blood was given and no surgical complications occurred. 3 months later, with only iron therapy, her hemoglobin level rose to 11.9 and she is in good health now.
- Korean Research Society of Transfusion Alternatives Symposium, 2006

Just 20 years ago, things we couldn’t even imagine are now happening in the medical profession. All of the above teams did not use blood, yet they saved lives. Currently, more than 150,000 doctors in 150 countries use transfusion alternative treatments, because these doctors believe that these treatments are simple, safe and effective. According to Wall Street Journal, “a growing number of hospitals are offering an alternative: "bloodless" surgery.” And same article described that “originally developed to accommodate Jehovah's Witnesses and others with religious objections to transfusions, the practice has gone mainstream, with many hospitals promoting their bloodless-surgery programs to the general public.” In Korea, as of February 2008, 14 university third grade hospitals are already using transfusion alternatives widely as well as over 200 hospitals in the United States. What is the reason, then, performing transfusion treatment was on the decrease, despite the fact transfusion treatment was widely and dramatically used since World War II? In the Korean War 22% of the patients, who received transfusion of plasma, contracted and suffered hepatitis. This is three times the ratio of patients who received same transfusion and suffered hepatitis in World War II.

Up until the 1970’s it is estimated that 3,500 people died every year of transfusion related hepatitis in the United States since World War II. Granted, with better examination techniques and careful selection of blood donors, hepatitis B infected people can be and in fact are reduced. However, with blood transfusions, tens of thousands of Americans are estimated to be infected with a new type of virus, hepatitis C.

Another shocking fact struck the world in the 1980s, bursting numbers of people infected with HIV virus in many countries. Once known as life-saving blood now became a liquid that claimed the lives of many! Innocent victims and their families were in despair. There were even suicides occur among those who found out that they were infected with AIDS. With this tragic development, government authorities and those in the medical profession took drastic measures. ‘Blood safety’ became the most urgent issue! Authorities screening the blood donors began strengthening the examination of donated blood/management systems. Doctors became cautious in blood use. The general public situation was no different as they could not trust the transfusions as well. In fact, a survey held in 1996 of the general polls showed that 89 % of Canadians preferred alternative treatment over donated blood.

Journal of Vascular Surgery tells this: “not all patients will refuse homologous transfusion as do Jehovah's Witnesses. Nonetheless, the risks of disease transmission and immunomodulation offer clear evidence that we must find alternatives for all of our patients.”