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Some patients object to receiving blood or blood products as part of their medical treatment. Many of these individuals are of the Jehovah's Witness faith and refuse the transfusion of another person's blood based on strict interpretations of both Old and New Testament texts that refer to the sanctity of blood.[120] This religious sect currently has over 6 million active and 14 million associated followers worldwide, and its publications are translated into over 200 different languages. In the 1980s, bloodless medicine programs were started at the
| Preoperative assessment and planning: |
| Management of anemia |
| Management of anticoagulation and congenital and drug-induced coagulopathies |
| Prophylactic interventional radiology and embolization |
| Prescribing and scheduling of cell salvage apparatus |
| Restricted diagnostic phlebotomy |
| Intraoperative blood conservation: |
| Meticulous surgical hemostasis |
| Blood salvage |
| Hemodilution |
| Pharmaceutical enhancement of hemostasis |
| Maintenance of normothermia |
| Surgical positioning to minimize blood loss and hypertension |
| Postoperative blood conservation: |
| Blood salvage |
| Tolerance of anemia |
| Optimum fluid and volume management |
| Restricted diagnostic phlebotomy |
| Adequate analgesia, maintenance of normothermia |
| Maintain appropriate fluid resuscitation. Significant normovolemic anemia is well tolerated in hemodynamically stable patients. |
| In actively bleeding patients, the first management priority must be to stop the bleeding. Avoid attempts to normalize blood pressure until bleeding is stopped. |
| Prevent or treat coagulation disorders promptly. |
| Oral or parenteral iron may be used to improve iron stores. Exogenous erythropoietin therapy effectively increases RBC mass. |
| Hematology and oncology: |
| Aggressive exogenous erythropoietin therapy and iron therapy for the prophylaxis of anemia |
| Individualized chemotherapy protocols to minimize hematologic toxicity |
| Pharmacologic prophylaxis and treatment of bleeding |
| Tolerance of anemia |
| Restricted diagnostic phlebotomy |
| RBC, red blood cell. |
| From Goodnough LT, Shander A, Spence RK: Bloodless medicine: Clinical care without allogeneic blood transfusion. Transfusion 43:668–676, 2003. |
Recently, a substantial proportion of the population in the United States, regardless of their religious background, has voiced concern about the safety of blood transfusions. A telephone survey found that only 61% of the respondents felt the blood supply in the United States was safe, and 33% said that they would refuse blood transfusions if hospitalized.[9] In the past decade, public concern about problems with the blood supply and shortages in the availability of volunteer blood donors have also led to the development of bloodless medicine centers.
Bloodless medicine and surgery is defined as a team approach "that reduces blood loss and uses the best available alternatives to allogeneic transfusion therapy while focusing on the provision of the best possible medical care to all patients."[121] The objectives of a bloodless medicine program should include "providing leadership within an institution for bloodless medicine and being the advocate for patients not accepting transfusion."[122] All clinicians should realize that a philosophy of blood management that incorporates the avoidance of unnecessary blood transfusions in all patients is appropriate even if a bloodless medicine center does not exist at their institutions.[3] The general principles of surgical and anesthetic bloodless management are detailed in Table 48-8 .
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