Originally posted by FredT
Reply to post by The Great Day
kindly show me what bloodless option is avalible in a potential life or death situation.
If you need blood emergently you need blood. There is no substitute.
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"We must conclude that currently there are many patients receiving blood components who have no chance for a benefit from transfusion (the blood is
not needed) and yet still have a significant risk of undesired effect. No physician would knowingly expose a patient to a therapy that cannot help but
might hurt, but that is exactly what occurs when blood is transfused unnecessarily." —Transfusion-Transmitted Viral Diseases, 1987.
Are there legitimate and effective ways to manage serious medical problems without using blood? Happily, the answer is yes.
Though most surgeons have claimed that they gave blood only when absolutely necessary, after the AIDS epidemic arose their use of blood dropped
rapidly. An editorial in Mayo Clinic Proceedings (September 1988) said that "one of the few benefits of the epidemic" was that it "resulted in
various strategies on the part of patients and physicians to avoid blood transfusion." A blood-bank official explains: "What has changed is the
intensity of the message, the receptivity of clinicians to the message (because of an increased perception of risks), and the demand for consideration
of alternatives." —Transfusion Medicine Reviews, October 1989.
Note, there are alternatives! This becomes understandable when we review why blood is transfused.
The hemoglobin in the red cells carries oxygen needed for good health and life. So if a person has lost a lot of blood, it might seem logical just to
replace it. Normally you have about 14 or 15 grams of hemoglobin in every 100 cubic centimeters of blood. (Another measure of the concentration is
hematocrit, which is commonly about 45 percent.) The accepted "rule" was to transfuse a patient before surgery if his hemoglobin was below 10 (or 30
percent hematocrit). The Swiss journal Vox Sanguinis (March 1987) reported that "65% of [anesthesiologists] required patients to have a preoperative
hemoglobin of 10 gm/dl for elective surgery."
But at a 1988 conference on blood transfusion, Professor Howard L. Zauder asked, "How Did We Get a 'Magic Number'?" He stated clearly: "The
etiology of the requirement that a patient have 10 grams of hemoglobin (Hgb) prior to receiving an anesthetic is cloaked in tradition, shrouded in
obscurity, and unsubstantiated by clinical or experimental evidence." Imagine the many thousands of patients whose transfusions were triggered by an
'obscure, unsubstantiated' requirement!
Some might wonder, 'Why is a hemoglobin level of 14 normal if you can get by on much less?' Well, you thus have considerable reserve oxygen-carrying
capacity so that you are ready for exercise or heavy work. Studies of anemic patients even reveal that "it is difficult to detect a deficit in work
capacity with hemoglobin concentrations as low as 7 g/dl. Others have found evidence of only moderately impaired function." —Contemporary
Transfusion Practice, 1987.
While adults accommodate a low hemoglobin level, what of children? Dr. James A. Stockman III says: "With few exceptions, infants born prematurely
will experience a decline in hemoglobin in the first one to three months . . . The indications for transfusion in the nursery setting are not well
defined. Indeed, many infants seem to tolerate remarkably low levels of hemoglobin concentration with no apparent clinical difficulties."
—Pediatric Clinics of North America, February 1986.
"Some authors have stated that hemoglobin values as low as 2 to 2.5 gm./100ml. may be acceptable. . . . A healthy person may tolerate a 50 percent
loss of red blood cell mass and be almost entirely asymptomatic if blood loss occurs over a period of time." —Techniques of Blood Transfusion,
Such information does not mean that nothing need be done when a person loses a lot of blood in an accident or during surgery. If the loss is rapid and
great, a person's blood pressure drops, and he may go into shock. What is primarily needed is that the bleeding be stopped and the volume in his
system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation.
Volume replacement can be accomplished without using whole blood or blood plasma.* Various nonblood fluids are effective volume expanders. The
simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as
dextran, Haemaccel, and lactated Ringer's solution. Hetastarch (HES) is a newer volume expander, and "it can be safely recommended for those [burn]
patients who object to blood products." (Journal of Burn Care & Rehabilitation, January/February 1989) Such fluids have definite advantages.
"Crystalloid solutions [such as normal saline and lactated Ringer's solution], Dextran and HES are relatively nontoxic and inexpensive, readily
available, can be stored at room temperature, require no compatibility testing and are free of the risk of transfusion-transmitted disease." —Blood
Transfusion Therapy —A Physician's Handbook, 1989.
You may ask, though, 'Why do nonblood replacement fluids work well, since I need red cells to get oxygen throughout my body?' As mentioned, you have
oxygen-carrying reserves. If you lose blood, marvelous compensatory mechanisms start up. Your heart pumps more blood with each beat. Since the lost
blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels. As a result of chemical changes, more
oxygen is released to the tissues. These adaptations are so effective that if only half of your red cells remain, oxygen delivery may be about 75
percent of normal. A patient at rest uses only 25 percent of the oxygen available in his blood. And most general anesthetics reduce the body's need