Bloodless surgery is a common reference to a number of different techniques that make it possible for a patient to undergo a complex surgery without the need for a blood transfusion. The term can be a little confusing at first, seemingly implying a surgical procedure where no blood is used. Instead, the field of bloodless medicine involves taking specific measures before, during and after a surgery to conserve as much of the patient's own blood as possible. This can be accomplished in a number of different ways, including pre-surgery diet monitoring, the use of special surgical tools, and the application of advanced surgical techniques and procedures.

To better understand the principles of bloodless medicine, it helps to have an understanding of why blood transfusions are necessary in the first place. Hemoglobin is a protein in red blood cells that allows the blood to carry oxygen to all parts of the body. When a person loses a large volume of blood, the amount of oxygen delivered to the vital organs is reduced. Blood transfusions are administered to patients who have lost considerable amounts of blood during surgery. By replenishing the blood that was lost, the patient's organs begin to receive more oxygen. This is believed to reduce the risk for infection and increase recovery speed.

Techniques and Methods used in Bloodless Medicine -

A bloodless surgery can include any number of elements, many of which depend on the particular hospital's bloodless medicine program, the level of surgeon experience, the patient's preference, and the operation to be performed. These elements include pre-surgery preparations, medications and techniques during surgery, and post-surgery considerations. Below are just a few of the techniques, methods and procedures that can be used in a bloodless surgery:

Pre-Surgery -

• Increased iron in diet

• Blood screening for anemia

• Stopping smoking

• Stopping certain medications

• Hematopoetic agents, including (procrit, aranesp)

During Surgery -

• Monitoring blood oxygen levels

• Special anesthesia

• Administering oxygen

• Blood boosting supplements

• Minimally invasive techniques

• Specially designed surgical tools and instruments

• Blood salvage or recovery

Post-Surgery -

• Careful blood monitoring

• Body temperature monitoring

• Oxygen therapy (hyperbaric chambers)

• Nutritive considerations

It is worth noting that sometimes bloodless medicine does not involve any special techniques or procedures at all. It can be as simple as the surgical team allowing the patient's hemoglobin levels to dip to lower - but still stable - levels. As long as the surgeon is confident that the patient is safe, the surgery can proceed without a transfusion.

Why Have a Bloodless Surgery?

There are a number of different reasons why a patient might choose to undergo a bloodless surgery instead of receiving a traditional blood transfusion:

• Reducing the Risk of Infection and Disease

• Religious Beliefs

• Rare Blood Types/Blood Shortages

• Avoiding other Complications

Reducing the Risk of Infection and Disease -

Many individuals wish to have a bloodless surgery because of concerns they might contract an infection or disease by receiving a blood transfusion from a contaminated source. There are an alarming number of infectious agents that have been found in the US blood supply, including:

• Human Immunodeficiency Virus (HIV)

• Malaria

• Syphilis

• Herpes Viruses

• Hepatitis A, B and C

• West Nile Virus

• And many others

While blood donor banks take great caution and care to ensure the blood supply is safe, there is never a 100% guarantee that a blood transfusion will include perfectly save blood that is free of infectious agents.

Religious Beliefs -

Members of some religions - most notably Jehovah's Witnesses - are unable to accept blood products via transfusion because of their beliefs. The specific reasons vary depending on the religion. Jehovah's Witnesses, for example, believe that human blood is sacred and cannot be taken into the body from an outside source, nor can it be removed from the body and stored.

There are a number of different bloodless surgery techniques which are considered acceptable by the Jehovah's Witnesses system of beliefs. These include minimally invasive surgical techniques which limit blood loss, oxygen therapy during and after surgery, and many others.

Rare Blood Types and Blood Supply Shortages -

There are certain blood types (AB negative) which are less common than others. Of course, there are also circumstances where a patient's blood type could be temporarily unavailable when and where it is needed. Bloodless surgeries and reducing the use of donor blood provide a way around these roadblocks.

Avoiding other Complications -

A blood transfusion is a surgical procedure and, as with any surgical procedure, there are a number of different complications that may arise. The wrong blood type could be administered. The patient might experience an allergic reaction to some agent present in the blood.

Even under these concerns, blood transfusions are relatively common procedures. More than 14 million of them are carried out every year, the vast majority of them with little or no complications.

As public interest in bloodless medicine and other blood transfusion alternatives continues to grow, more and more hospital systems are incorporating bloodless surgery programs. Contact your local hospital for more information if bloodless surgery is available.