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A blood-recovery machine known as a cell saver, seen here during a prostate operation, suctions off blood, cleans it and returns it to the patient |
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| In one especially difficult case that Shander oversaw at
Englewood, 11-year-old Cristali Rodriguez came in with a rare
pancreatic tumor, one of only 300 documented cases worldwide.
Doctors in Philadelphia had declined to perform a Whipple
procedure, a complex reconstruction of the digestive tract
rarely performed on a child. Rodriguez's parents had refused a
blood transfusion, and the girl's doctors felt that without it
the operation was even more risky. Undeterred, Englewood
surgeons did a 10-hour bloodless Whipple. There were no major
complications, and a week later Cristali was eating pizza. Soon
after her discharge, she was back in school.
Up to now, Jehovah's Witnesses, who have long demanded equal medical care without having to compromise their religious beliefs, have made up some 90% of those who seek the bloodless techniques. But increasing numbers of other patients today refuse transfusions out of fear of blood-borne diseases such as aids and hepatitis, not to mention unidentified viruses. Their concern is not always misplaced. Blood transfusions, while safer today than in the past, are not risk free. The chance of contracting aids from a unit of blood, for instance, is 1 in 500,000, and 1 in 103,000 for hepatitis C, according to the National Institutes of Health. The risk becomes greater as more units are transfused. "If you get 10 units of blood, the risk of hiv infection becomes 1 in 50,000," says George Nemo, leader of a group investigating transfusion medicine at the National Heart, Lung and Blood Institute. "If you're in an automobile accident, and you need 100 units, you're down to one in 5,000." Even when donor blood is deemed safe, if blood of the wrong group is transfused by mistake, recipients may suffer kidney failure, shock and clotting difficulties. Differences between donor and recipient platelets, white cells and plasma proteins can also cause reactions. Even donating one's own blood for use during surgery can be hazardous if the blood is mishandled. Other factors make bloodless surgery increasingly attractive. Transfusions can suppress the immune system, for example, leaving a patient open to infection, slower healing and a longer recovery time. "Also, banked blood, after it's cooled and stored, doesn't have the capability of fresh blood to transport oxygen," says Shander. "We're just beginning to understand what it is we do when we give a transfusion." Finally, there is the cost: at around $500 for each transfusion, plus administrative add-ons, the total bill comes to between $1 billion and $2 billion annually, more than enough incentive to consider alternatives. Already, Englewood Hospital's managers claim, they have cut blood usage 20% and racked up savings in labor costs by lowering infection rates and shortening hospital stays.
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