Morat

Okay, this is the best forum I can come up with for this.

Elsewhere the topic has turned to blood transfusions. Our resident (and quite polite) JW's have come in to discuss it.

Bloodless surgery has come up (which is the rather intelligent idea of simply minimizing the need for transfusions), as well as a laundry list of things doctors can do to prevent the need for transfusions.

So what I'm wondering is: How often are transfusions necessary? What sorts of things demand them the most? How effective can doctors be at minimizing the need for transfusions?

And most importantly, how much extra risk do you assume from refusing to accept transfusions? How does it affect your mortality statistics?

Anyone got any data?

Dr Rick

There is surprisingly little evidence to guide the use and adminstration of blood products in clinical practice, and yet over 11,000,000 units of blood products were transfused in the US last year.

Part of the reason is that practical and ethical considerations prevent us from performing randomized trials that allow us to see how low blood counts can go before inducing death, but it has nonetheless become clear that a lot of false assumptions were made which recent data has refuted regarding the "thresholds" at which blood should be transfused.

How well a particular individual tolerates anemia is dependent on many factors, including rate of blood loss ( a slow loss such as occult internal bleeding that may go on for months or years without detection allows for more time to compensate than an acute, massive hemorrahge) and his/her general condition.

It has become evident through recent studies that up until just a few years ago we were "overtransfusing" patients, particularly the critically-ill. As a result, guidelines were established that dropped the transfusion threshold for an otherwise healthy person from 10 g/dl of hemoglobin to 7 or 8. Also, hospitals in the US have been mandated to monitor blood product usage and retrospectively review every transfusion ordered for medical necessity. Physicians that "fall-out" are asked to correct their practices.

Overall, most surgeries and injuries don't require transfusions, and for those elective surgeries where the potential need for blood products is high, autologous (self-donated) blood can be banked (though practicing JWs are prohibited from this practice, too).

On a related topic, the risk of acquiring HIV or viral hepatitis from a blood transfusion in the US now is estimated to be from 1/50,000 to 1/100,000 or less. Estimated, because since all US blood banks began screening for these illnesses in the early 1990's, there has not been one single documented case of transfusion-associated HIV or viral hepatitis transmission.

Rick

[ June 02, 2002: Message edited by: rbochnermd ]</p>