Treatments that minimize or eliminate the use of blood products...

Treatments that minimize or eliminate the use of blood products in surgical procedures are gaining a wider audience, say Dr. Aaron Harrison, associate medical director at South Shore University Hospital, left, and Dr. John Davis, the hospital's surgery director. Credit: Barry Sloan

Bloodless medicine, treatments that minimize or eliminate the use of blood products in surgical procedures, is gaining a wider audience, including on Long Island, where doctors say transfusions can be overused.

The practice has been championed by members of the Jehovah’s Witness community, whose beliefs clash with the concept of blood transfusions. But many doctors and patients outside the community are also embracing the techniques.

Dr. Aaron Harrison, associate medical director at South Shore University Hospital in Bay Shore, which is ramping up its bloodless medicine program, said while transfusions are safe and common procedures, they can cause complications to the recipients such as allergic reactions and injuries to the lungs.

“More patients are taking advantage of this program,” he said. “And sometimes people, emotionally and psychologically, don’t want to get blood.”

WHAT TO KNOW

  • Minimizing or eliminating the use of blood products during surgical procedures, techniques traditionally used to treat members of the Jehovah’s Witness community, are being used by a broader section of the public.
  • South Shore University Hospital in Bay Shore is ramping up its bloodless medicine program.
  • One treatment being used can boost the blood count for an anemic person before elective surgery and reduce the possible need for a blood transfusion.

This is part of a greater shift among some in medicine who believe other options should be used before blood transfusions.

“You don’t want to give people blood if they don’t need it for a variety of reasons,” he said. “We would like to reduce the number of transfusions for all patients.”

There are various blood management techniques, such as reducing the amount of blood drawn for tests, stopping blood thinners and doing robotic surgery. A person’s own blood can be “recycled” and returned to them during surgery.

Hospitals across Long Island, including South Shore, Stony Brook, NYU Langone-Long Island and Mount Sinai South Nassau, offer different bloodless medicine treatments for patients, according to officials at those institutions.

Over the last year, South Shore has expanded one treatment that allows anemic patients planning elective surgeries to boost their red blood cell count and possibly stave off the need for a transfusion on an outpatient basis.

The treatment involves giving patients an infusion of iron and a hormone called erythropoietin a few weeks before the surgery. This combination stimulates the bone marrow to produce red blood cells, improving their anemia and reducing the need for transfusions during or after surgery, Harrison said.

Dr. Steven M. Frank, medical director of the Center for Bloodless Medicine and Surgery at Johns Hopkins Hospital, said he believes that more patients eligible for this treatment should be receiving it before going into surgery.

“Pre-op anemia treatment is underutilized,” said Frank, who is also a professor of anesthesiology and critical care medicine at Johns Hopkins Medical Institutions. “We are still letting patients come in for elective surgeries anemic and treating them with a blood transfusion that they could avoid.”

Dr. James McGinty, chief of surgery and surgical services at Englewood Health in New Jersey, which has a well-known bloodless medicine program, said in an email that transfusions should "only be used in life-threatening emergencies" because of the risks involved.

How it works

Before a patient undergoes an operation, they are tested for a variety of conditions, including anemia.

If a patient is anemic, they don’t have enough red blood cells, which hold the important task of carrying oxygen to tissues in the body. 

Vials of drugs used to help anemic patients as part...

Vials of drugs used to help anemic patients as part of a bloodless medicine treatment, at South Shore Hospital last month. Credit: Barry Sloan

Anemia affects about 10% of the population and is more prevalent in women of childbearing years and in the elderly, McGinty said.

"Iron deficiency anemia is most common and occurs from inadequate iron intake or chronic blood loss, such as a heavy period," he said.

Anemic patients could need a blood transfusion during surgery, even in common elective procedures such as knee and hip replacement.

“With a hip surgery, for example, you can lose the equivalent of probably a unit of blood between the actual day of surgery, the operation itself and ongoing blood loss into the tissues over the course of the first day post operatively,” said Dr. Don DeCrosta, chair of anesthesia at South Shore University Hospital.

Anemic patients who undergo the treatment receive a shot of erythropoietin and an intravenous infusion of iron that takes about 20 minutes, he said.

“Within a relatively short period of time — a week to two weeks — you will see the anemia begin to resolve,” DeCrosta said. “Erythropoietin works to stimulate the bone marrow to produce red blood cells … iron is needed because the way the red blood cells pick up oxygen is with a molecule called hemoglobin and iron is at the center of the hemoglobin molecule.”

Andrea Acerra, a senior medical assistant from Lindenhurst, underwent the treatment before having a hysterectomy last year.

Andrea Acerra, a senior medical assistant from Lindenhurst, preferred avoiding...

Andrea Acerra, a senior medical assistant from Lindenhurst, preferred avoiding a blood transfusion. Credit: Barry Sloan

Heavy menstrual periods had left Acerra, 45, anemic. She discussed the options with her doctors, and while Acerra said she wasn't opposed to having a transfusion, if needed, she was happy to avoid it.

"I’m sure it was far less traumatic than needing a transfusion during or after surgery, and I think everyone should be told that it is an option," she said. "I think it is something that should be widely used throughout medicine."

Dr. John Davis, surgery director at South Shore, said there appears to be growing interest in bloodless medicine techniques such as the iron/erythropoietin treatment.

But he said erythropoietin has to be administered in a way that is carefully tailored for each patient so people who have been anemic are not pushed to have higher levels of hemoglobin than their bodies can handle.

“There’s data that shows you will feel better and are less likely to stay in the hospital longer,” compared to having a transfusion, said Davis, who has worked on bloodless medicine programs in New Jersey.

Downside of transfusions

Problems with tainted blood that arose during the early days of the AIDS crisis left many people concerned about the safety of transfusions. But Frank said those risks largely have been eliminated.

“We used to worry about HIV and hepatitis C in the 1980s and 1990s,” he said. “With the testing we have, the chances of getting HIV or hepatitis C is one in 2 million transfusions. This is the same risk, by the way — this is a formal study — of getting struck and killed by lightning in the United States. There are other side effects from blood that are much more common.”

He noted that a person’s immune system is suppressed by banked blood, which puts them more at risk for infection.

“As a general rule, it’s always better not to take a medication, for example, if you don’t really need it,” DeCrosta said. “That’s especially true with infusion of blood products.”

Other side effects include possible damage to the liver and heart from having too much iron in the body, as well as allergic reactions.

Jehovah’s Witness community

The Jehovah’s Witness community has received a lot of attention over the years for its complex relationship with medicine.

But what many people don’t know, Davis, the surgery director at South Shore, said, is that the community’s important support for bloodless medical procedures has advanced research that can help all patients.

“They have been sort of leaders in using erythropoietin and iron,” Davis said. “They let the rest of the world know how safe and effective it is.”

Robert J. Hendriks III, a U.S. spokesman for Jehovah’s Witnesses, said its members seek the best medical treatment available and embrace modern medical advances.

“We love life and we will do anything that is reasonable to remain alive,” said Hendriks, who grew up in Central Islip and lived in Bay Shore. “Patient blood management really is the gold standard of medical treatment … It’s promoting a culture where patients' own blood is viewed as precious and is preserved.”

Witnesses do not take blood products into their bodies, but they do use clinical methods to manage hemorrhages and anemia, he said.

"We have felt an obligation as a result of that stand to assist the medical community in order to find ways to keep us alive, and that assistance has led to millions of others around the world who have also benefited greatly from that research," Hendriks said.

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