The question of blood transfusions has always interested me and one that bothered me about the beliefs of Jehovah’s Witnesses. I have met and spoken to some Jehovah’s Witnesses recently and brought the subject of blood transfusions up to get their thoughts. I was surprised very much by what they had to say. Here is what one of their followers had to say, who just happens to be an expert on the subject of blood transfusion alternatives. His name is Mark Tarrant.
The answer is not as simple as you might think. Many have to ask the question. It’s become a question each time a patient presents for surgery, it’s a question for the surgeon, as to whether or not he uses blood in surgery is a clinical decision. It’s a question for hospital managers who handle hospital budgets and hence have to account for blood use. And it has been a question for the religious stretching back centuries.
Perhaps most famously in modern times, it has become a question associated with the patient who is one of Jehovah’s Witnesses. Is their decision to decline blood an irrational one?
Let’s start by asking why the surgeon may ask “Blood or no Blood?” In Britain, blood use in surgery has fallen 20% in the last ten years. Why? Quite simply because blood transfusions are not risk-free and complicated surgery is routinely done safely, without recourse to blood.
In classifying potential risks the paper “Patient Blood Management in Europe” Shander et al includes “Transfusion -transmitted infection complications (e.g. HIV and hepatitis) immunological complications (e.g. immunomodulation resulting in postoperative infection, sepsis, antibody-medicated alloimmunization, graft-vs-host disease haemolytic transfusion reactions and allergic reaction) …transfusion related lung injury…and non-infectious, non- immunological complications (e.g. acute lung injury, transfusion errors, non-haemolytic and haemolytic reactions, circulatory overload and metabolic disturbances)
In 2014 the NHS adopted a programme called Patient Blood Management. Its aim is self- evident; to manage the patient’s own blood. The programme has three over-arching aims.
First, to optimise patients prior to surgery. Making the patient their own “blood bank” by raising their haemoglobin levels prior to surgery improves the outcome for the patient. Many hospitals have anaemia clinics for this very purpose. By avoiding operating on anaemic patients they reduce blood use and improve outcomes.
The second aim is to minimise blood loss in surgery. One technique involves using Cell Salvage. This process involves salvaging, processing and returning to the patient their own blood. This process means blood lost is not lost to the patient and the risk of complications associated with allogeneic transfusions are eliminated.
The third aim is to restore the patient’s haemoglobin levels post-surgery. One treatment is to use a single high dose of IV iron. It’s cheaper and has fewer risks than a transfusion.
Blood is a limited resource, it’s expensive and although it’s safer than it’s ever been, it is not risk free. The SHOT report which each year catalogues the negative outcomes form blood transfusions in the UK reports 115 transfusion related deaths between 2010 and 2016.
Hospital managers are also asking “Blood or no blood?” For them cost is a driving factor, how can the money go further? A unit of red Blood Cells costs currently around £140. However, the paper Patient Blood Management in Europe says “The true costs of transfusion services are likely to have been underestimated due to their complexity…The totals costs were 3 to 5 fold higher than blood acquisition costs alone. Indirect costs have previously been associated with the legal ramifications of blood supplies and also the personal costs to affected donors and patients.”
By Mark Tarrant & Rick Klink
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