Minimizing blood loss

When shooting stomach pains sent Jeanette Alberty to Sacred Heart Medical Center recently, she made sure everyone who cared for her there knew one very important thing:

She did not want — under any circumstance — a blood transfusion.

Alberty is a Jehovah’s Witness. The Spokane woman, like others who share her faith, adheres to a literal interpretation of the Bible in which blood is sacred. Even in circumstances of life and death, Jehovah’s Witnesses will not accept blood.

“It’s just something I believe in,” says Alberty, a crossing guard and assistant at Audubon Elementary School.

Alberty felt like her faith would be respected at Sacred Heart. During her stay, she wore a “no blood” wrist band. A sign with the same message hung over her bed.

For the last three years, the hospital has run a Blood Management Program that combines technology with innovative techniques to reduce, or eliminate, the need for blood transfusions. Deaconess Medical Center operates a “bloodless” medicine and surgery program as well.

“We honor the patients’ wishes,” says Judy Demand, a registered nurse at Deaconess who is in charge of the Bloodless Medicine and Surgery program. “It really does set their minds at ease when they get that ‘no-blood’ band on.”

There are now more than 100 such programs in hospitals around the country, says Robert Kopchinski, executive director of the Milwaukee-based Society for the Advancement of Blood Management.

“The belief is that this is good for everybody, not just one particular religious group,” Kopchinski says.

About half of the 1,500 people who signed up for the Blood Management Program at Sacred Heart last year did so because of religious beliefs, says Lori Carlson, a licensed practical nurse and Jehovah’s Witness who is the program’s assistant. The other half simply hoped to avoid receiving a blood transfusion for other reasons, Carlson says.

“It’s as safe as it’s ever been,” Carlson says of blood transfusions. “But blood is never going to be totally safe.”

Adds Karen Stewart, the RN who manages the program, “After AIDS, people just became concerned.”

Besides concerns over blood safety, transfusions raise the risk of infection, experts say. And they raise the possibility of errors in which patients are given the wrong blood type.

Ideally, participation in the Blood Management Program begins well before a patient ever has an operation. (The techniques are also used in trauma cases, but it becomes trickier, Stewart and Carlson say.)

Patients should call the program as soon as they know they need a procedure, Stewart says. That way, coordinators can hook them up with a surgeon who is part of the program. There are some 90 surgeons, in all specialties, who are well-versed in blood-conservation techniques, Carlson says.

Patients then will be given drugs or supplements and instructed to follow an iron-rich diet to pump up their red blood cells.

Both Sacred Heart and Deaconess use cell salvage machines to collect blood lost during surgery, wash it and return it to the body. And newer, more portable units can be used in patients’ rooms to collect and return blood that has drained from an incision.

Nurses have also been trained to siphon much less blood when taking samples.

And doctors pay closer attention to a patient’s symptoms, and not just pure hemoglobin numbers, when considering a transfusion, says Dr. Mark Olson, an orthopedic surgeon who is the medical director of Sacred Heart’s blood management program.

It used to be that patients automatically would get a unit or two of blood when their hemoglobin dipped below 10 (normally it’s 13 to 15), Olson says. But Olson regularly sees patients at 6 or 7 who are functioning OK.

“Blood is often given without a thought as to what are the risks and what are the benefits,” he says.

It also used to be that the pumps used during open-heart surgery were primed with several units of blood before the operation, Stewart says. Now, those pumps are filled with saline or other solutions at the outset.

And, with advances in minimally invasive procedures, many surgeries are becoming less bloody.

“You can be assured there will be less chance you will need a blood transfusion,” Olson says.

Some patients still donate blood in advance of a procedure, a so-called “autologous” transfusion, but that is declining in popularity, says Steve McCormick, vice president of technical services for the Inland Northwest Blood Center.

“It’s probably half of what it used to be,” McCormick says.

Jehovah’s Witnesses will not accept autologous transfusions.

It’s hard to say whether advances in reducing transfusions have slowed demand for blood donations. Area hospitals increasingly are doing more complicated procedures and surgeries, such as transplants, which often call for many units of blood. But reducing unnecessary transfusions is always a good idea, McCormick says.

“We should never transfuse people when it’s not needed,” he says.

Elizabeth Wolfe traveled to Spokane from her home in Pullman to have two knee-replacement surgeries at Sacred Heart, where she would be assured she would not receive a blood transfusion.

She was never in danger of needing a transfusion during the two operations, she says, but felt comfortable because of all of the precautions taken to prevent blood loss.

“It was a good experience,” says Wolfe, a Jehovah’s Witness who works at Washington State University. “I think it’s a great program. … (But) you don’t have to be a Jehovah’s Witness to take advantage of the program. Those doctors in that program are cutting-edge.”