Transcending the Traditional Approach

When you think of surgery, you probably think of blood -- the loss of it and the need to replace it. It's time to change this way of thinking. It's just such a paradigm shift among physicians that has led to the emergence of a new medical specialty: bloodless medicine and surgery. University Hospital is one of only a handful of hospitals in the country that practices this state-of-the-art approach to medical and surgical care.

Transfusion-free

Bloodless medicine and surgery emerged from efforts to honor religious and other personal beliefs of individuals who refuse blood transfusions. It employs new pharmaceuticals, advanced technology, and improved medical and surgical techniques to minimize blood loss, which in turn alleviates the need for transfusion.

"Until recently, the prevailing mind-set was when in doubt, it's better to transfuse than not to transfuse" says Edwin Deitch, M.D., chief of surgery at UMDNJ-University Hospital and chair of the Department of Surgery at the New Jersey Medical School. "However, we now know that the body functions perfectly well at lower than normal blood levels - as much as 50 percent lower than normal.

"Also, as we've learned more and more about blood, we've found that transfusions carry some risk. Donor screening and tests have virtually eliminated the risk of transmission of viruses such as hepatitis and HIV, the virus that causes AIDS. According to Food and Drug Administration experts, the blood supply is reasonably safe and patients can accept it with confidence.

"Still, transfusion will always carry some risk," says Dr. Deitch. "Blood is human tissue. When you receive a transfusion from someone other than yourself, your body treats it as a foreign substance." This impairs the immune response in such a way that the body's ability to fight infection is impaired. Dr. Deitch points out that the body's ability to fend off foreign material -- including cancer cells -- is reduced, as well. "In fact, research suggests that transfusion during colon cancer surgery may increase the risk of cancer recurrence," he says.

There are patients who clearly require and benefit from blood transfusions, such as those suffering severe trauma. But the vast majority of surgical patients -- even those undergoing open-heart surgery -- can take advantage of transfusion-free or bloodless surgery.

"However, a hospital must be committed to transfusion-free medicine, in order for it to happen," says Dr. Deitch. That commitment begins before a patient is wheeled into the operating room. "A common cause of blood loss is testing. By using pediatric tubes, microsamples and other techniques, we can take a fraction of the amount of blood that was taken previously," says Dr. Deitch.

In preparation for surgery, a patient also may be given the drug erythropoietin and iron to stimulate the bone marrow's production of red blood cells.

During surgery, blood loss can be conserved through a variety of approaches:

The latest techniques -- Meticulous technique and state-of-the-art surgical instruments, such as lasers and heaterprobes, can minimize blood loss.

Recycling blood -- In certain cases, blood can be salvaged or recycled, says Dr. Deitch. "For example, blood that spills in the chest or abdominal cavity, can be sucked up by a special machine that reprocesses it and reintroduces it into the body," explains Dr. Deitch.

Blood substitutes -- When blood levels drop below normal, a blood substitute can be given to expand blood volume, alleviating the need for transfusion.

The wave of the future today

Medical and surgical care without transfusion is growing in popularity and is expected to become the "gold standard." And University Hospital is leading the way, with a commitment to bloodless medicine and surgery firmly in place. In addition to the latest technology and pharmaceuticals and a highly knowledgeable and experienced team of medical professionals, we have the advanced mind-set that contributes to successful bloodless operations.

Every effort is made to reduce blood loss, which in turn reduces the need to transfuse. At University Hospital, neurosurgeons perform brain surgery using state-of-the-art computer mapping to minimize the invasive nature of the procedure. Cardiac surgeons have successfully treated patients using bloodless techniques for coronary bypass surgery, and surgeons at the New Jersey Trauma Center have treated critically injured accident victims with similar blood-saving procedures.

Also, protocols have been established so that transfusion-free medical or surgical care is practiced consistently and throughout the scope of services that we provide.

For more information on the bloodless medicine and surgery program at University Hospital or for a referral to a physician who practices this approach to medical and surgical care, call 1-888-BLD-LESS (253-5377).

This article appeared in an issue of "University Health Quarterly", the newsletter of UMDNJ-University Hospital. For a free, hard copy subscription to "University Health Quarterly", send your name and address to preislro@umdnj.edu