JOSIE HUANG
Over the last five years, surgeons have replaced Iris Carr's knees, repaired a hip, removed a gall bladder. They have opened her chest to slice away a tumor from her heart.
Not one of those times was she given any blood.
A Jehovah's Witness, Carr is forbidden from getting blood transfusions. So she built up her blood level ahead of time by taking bioengineered drugs and intravenous iron supplements. During open-heart surgery, when blood loss is particularly heavy, Carr's doctors at Maine Medical Center in Portland suctioned off blood that had pooled around the incisions so it could be washed in a machine and returned to her body.
Carr returned home to Cape Elizabeth slightly anemic, but within a couple weeks her blood count was back to normal. And she did not develop any of the infections that can result from receiving someone else's blood: "I'm glad I went through with it," Carr, 89, said.
Bloodless medicine used to be geared toward people with concerns about transfusions. But studies showing that skipping transfusions results in faster recoveries -- and therefore lower hospital costs -- has more medical leaders saying the practice should be for everybody. Maine's largest hospitals are the latest to join a movement among medical facilities to turn no-transfusion medicine from an offering by some of its doctors into a standard of care.
Eastern Maine Medical Center in Bangor started a blood management program with a medical director more than a year ago, while Maine Med this year hired a medical director to lead theirs. A committee of doctors from different departments at Central Maine Medical Center in Lewiston has been meeting on the issue since last spring.
All three hospitals have spent the last several years on reducing transfusions in cardiac surgery, which historically has higher rates of transfusion. Today, both EMMC and Maine Med transfuse roughly a quarter of their patients. CMMC did not provide figures.
"Patients always ask, 'What are the chances of me getting a blood transfusion?'" said Dr. Robert Kramer, a cardiac surgeon who works on quality improvement projects at Maine Med. "We used to say 50/50. Now it's less, and we're hoping to get it even lower and lower."
There still is a need for transfusion in certain situations: the victim of a car crash, or a woman who keeps bleeding after giving birth, may have lost so much blood that a transfusion is the only option.
But even in emergencies, blood conservation techniques can be used so that transfusions can be kept to a minimum, according to the Society for the Advancement of Blood Management, which represents more than 120 blood management programs around the country.
Not only is bloodless medicine safer, it removes the need to buy blood, an increasingly expensive commodity, the group said.
Ten years ago, a unit of blood cost $75 but now it is about $300, said Dr. Jonathan Waters, society president and Chief of Anesthesia Services at Magee-Womens Hospital of the University of Pittsburgh Medical Center. "Those costs have gone through the roof," Waters said. Most of the cost is coming from rigorous testing to make sure blood doesn't contain pathogens and viruses such as HIV or hepatitis. As a result the blood supply is the safest it has ever been, Waters said.
COMPLICATIONS STILL OCCUR
But blood recipients still risk developing transfusion-related problems such as renal or respiratory failure or an infection because the donor's blood is suppressing the patient's immune system. There is also the chance the patient will receive the wrong blood type and develop a bad reaction. For much of the last half-century, the medical community saw the benefits of transfusions as outweighing the risks. The value of donated blood gained wide recognition during the world wars, when advancements in blood storage and distribution helped to save soldiers on the front lines.
After World War II, American Red Cross blood centers and independent blood banks began to crop up across the country.
Interest in finding alternatives to transfusions began to surface with the rise of AIDS during the 1980s. There was also a growth in the number of Jehovah's Witnesses, who believe the Bible prohibits transfusions. An oft-cited verse comes from Genesis: "Only flesh with its soul -- its blood -- you must not eat."
Doctors, on an individual basis, have offered bloodless medicine for decades. In Maine, there are 90 of these doctors, up from just one in the 1970s, according to the Jehovah's Witnesses.
It took longer for hospitals to recognize transfusion-free medicine. The first hospital programs debuted in the 1990s, and began to use multiple blood conservation methods on a large scale.
In the weeks leading up to surgery, a patient could take synthetic erythropoietin or EPO, which stimulates production of red blood cells in the bone marrow.
On the day of the surgery, doctors could remove blood from the patient -- so fewer red blood cells will be shed -- to be returned to the body later. To make up for the lost volume, patient are injected with donated plasma -- the yellowish liquid that blood cells float in -- and saline solution.
OTHER STRATEGIES
Another strategy is to use a "cell-salvage" machine that collects blood pooling during the surgery and filters out the impurities for reinfusion into the body. After the surgery, doctors would make sure to draw smaller amounts of blood for testing than was taken in the past.
At Englewood Hospital, which has one of the oldest and busiest bloodless medicine programs in the country, the transfusion rate among patients receiving coronary artery bypass grafting -- one of the most common surgeries -- is down to 8 percent, said the program's medical director Dr. Aryeh Shander.
Maine hospitals are hoping for similar outcomes by formalizing blood management programs. Dr. Irwin Gross, who runs the EMMC program, said his challenge is to work with a medical establishment -- including doctors, nurses and technicians -- who have been hard-wired to see transfusions only as a life-saving tool.
"There's a lot of work to do in terms of education, changing physician practices and changing hospitals systems so the care is uniform," Gross said. The American Red Cross said the rise of bloodless medicine has taken some of the pressure off the donor blood supply.
"If somebody uses a blood conservation method -- and not a unit of blood -- that makes the unit available to another patient who may need it," said Dr. Patricia Pisciotto, chief medical officer of the Northeast Division of the Red Cross.
But Pisciotto added that bloodless medicine is not commonplace enough to reduce the need for volunteer donors. The Red Cross in Maine said it typically has only several days' worth of blood at any given time.
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Over the last five years, surgeons have replaced Iris Carr's knees, repaired a hip, removed a gall bladder. They have opened her chest to slice away a tumor from her heart.
Not one of those times was she given any blood.
A Jehovah's Witness, Carr is forbidden from getting blood transfusions. So she built up her blood level ahead of time by taking bioengineered drugs and intravenous iron supplements. During open-heart surgery, when blood loss is particularly heavy, Carr's doctors at Maine Medical Center in Portland suctioned off blood that had pooled around the incisions so it could be washed in a machine and returned to her body.
Carr returned home to Cape Elizabeth slightly anemic, but within a couple weeks her blood count was back to normal. And she did not develop any of the infections that can result from receiving someone else's blood: "I'm glad I went through with it," Carr, 89, said.
Bloodless medicine used to be geared toward people with concerns about transfusions. But studies showing that skipping transfusions results in faster recoveries -- and therefore lower hospital costs -- has more medical leaders saying the practice should be for everybody. Maine's largest hospitals are the latest to join a movement among medical facilities to turn no-transfusion medicine from an offering by some of its doctors into a standard of care.
Eastern Maine Medical Center in Bangor started a blood management program with a medical director more than a year ago, while Maine Med this year hired a medical director to lead theirs. A committee of doctors from different departments at Central Maine Medical Center in Lewiston has been meeting on the issue since last spring.
All three hospitals have spent the last several years on reducing transfusions in cardiac surgery, which historically has higher rates of transfusion. Today, both EMMC and Maine Med transfuse roughly a quarter of their patients. CMMC did not provide figures.
"Patients always ask, 'What are the chances of me getting a blood transfusion?'" said Dr. Robert Kramer, a cardiac surgeon who works on quality improvement projects at Maine Med. "We used to say 50/50. Now it's less, and we're hoping to get it even lower and lower."
There still is a need for transfusion in certain situations: the victim of a car crash, or a woman who keeps bleeding after giving birth, may have lost so much blood that a transfusion is the only option.
But even in emergencies, blood conservation techniques can be used so that transfusions can be kept to a minimum, according to the Society for the Advancement of Blood Management, which represents more than 120 blood management programs around the country.
Not only is bloodless medicine safer, it removes the need to buy blood, an increasingly expensive commodity, the group said.
Ten years ago, a unit of blood cost $75 but now it is about $300, said Dr. Jonathan Waters, society president and Chief of Anesthesia Services at Magee-Womens Hospital of the University of Pittsburgh Medical Center. "Those costs have gone through the roof," Waters said. Most of the cost is coming from rigorous testing to make sure blood doesn't contain pathogens and viruses such as HIV or hepatitis. As a result the blood supply is the safest it has ever been, Waters said.
COMPLICATIONS STILL OCCUR
But blood recipients still risk developing transfusion-related problems such as renal or respiratory failure or an infection because the donor's blood is suppressing the patient's immune system. There is also the chance the patient will receive the wrong blood type and develop a bad reaction. For much of the last half-century, the medical community saw the benefits of transfusions as outweighing the risks. The value of donated blood gained wide recognition during the world wars, when advancements in blood storage and distribution helped to save soldiers on the front lines.
After World War II, American Red Cross blood centers and independent blood banks began to crop up across the country.
Interest in finding alternatives to transfusions began to surface with the rise of AIDS during the 1980s. There was also a growth in the number of Jehovah's Witnesses, who believe the Bible prohibits transfusions. An oft-cited verse comes from Genesis: "Only flesh with its soul -- its blood -- you must not eat."
Doctors, on an individual basis, have offered bloodless medicine for decades. In Maine, there are 90 of these doctors, up from just one in the 1970s, according to the Jehovah's Witnesses.
It took longer for hospitals to recognize transfusion-free medicine. The first hospital programs debuted in the 1990s, and began to use multiple blood conservation methods on a large scale.
In the weeks leading up to surgery, a patient could take synthetic erythropoietin or EPO, which stimulates production of red blood cells in the bone marrow.
On the day of the surgery, doctors could remove blood from the patient -- so fewer red blood cells will be shed -- to be returned to the body later. To make up for the lost volume, patient are injected with donated plasma -- the yellowish liquid that blood cells float in -- and saline solution.
OTHER STRATEGIES
Another strategy is to use a "cell-salvage" machine that collects blood pooling during the surgery and filters out the impurities for reinfusion into the body. After the surgery, doctors would make sure to draw smaller amounts of blood for testing than was taken in the past.
At Englewood Hospital, which has one of the oldest and busiest bloodless medicine programs in the country, the transfusion rate among patients receiving coronary artery bypass grafting -- one of the most common surgeries -- is down to 8 percent, said the program's medical director Dr. Aryeh Shander.
Maine hospitals are hoping for similar outcomes by formalizing blood management programs. Dr. Irwin Gross, who runs the EMMC program, said his challenge is to work with a medical establishment -- including doctors, nurses and technicians -- who have been hard-wired to see transfusions only as a life-saving tool.
"There's a lot of work to do in terms of education, changing physician practices and changing hospitals systems so the care is uniform," Gross said. The American Red Cross said the rise of bloodless medicine has taken some of the pressure off the donor blood supply.
"If somebody uses a blood conservation method -- and not a unit of blood -- that makes the unit available to another patient who may need it," said Dr. Patricia Pisciotto, chief medical officer of the Northeast Division of the Red Cross.
But Pisciotto added that bloodless medicine is not commonplace enough to reduce the need for volunteer donors. The Red Cross in Maine said it typically has only several days' worth of blood at any given time.
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There is a doctor who treats fibroids, ovarian cysts, adenomyosis, endometriosis and chocolate cysts in women using
bloodless laser assisted surgery
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