Bloodless Medicine and Surgery Program at Georgetown University Hospital First in the Washington, D.C. Area

When Linda Lee, 57, of Washington, DC needed to have a non-cancerous tumor removed from her stomach in May of 2011 she was relieved to know that her surgery could be successfully performed in a way that respected her religious belief in not receiving a blood transfusion.

July 14, 2011

Procedures Performed to Honor Religious Beliefs Can Benefit All Patients

(Washington, D.C.) When Linda Lee, 57, of Washington, DC needed to have a non-cancerous tumor removed from her stomach in May of 2011 she was relieved to know that her surgery could be successfully performed in a way that respected her religious belief in not receiving a blood transfusion.

“As a Jehovah’s Witness I was not going to go against my belief not to receive blood. But I also understood that abdominal surgery very often requires a blood transfusion. After talking with my doctor at Georgetown and the staff of the bloodless medicine program, I felt confident about having the surgery I needed, without the blood transfusion I didn’t want,” said Linda Lee.

Ms. Lee’s physician was GI surgeon and Georgetown University Hospital’s vice president of Medical Affairs Stephen Evans, MD. Dr. Evans says that many patients request bloodless procedures. “This reflects a shift in medicine today. We are more sharply focused on reducing blood loss and eliminating the need for blood transfusions across the board. It’s simply good medicine since it addresses the concerns about blood borne diseases as well,” Dr. Evans said.

Mark Zawadsky, MD, an orthopaedic surgeon is medical director of the Bloodless Medicine and Surgery Program at Georgetown University Hospital, the first center in the Washington, DC area to have a comprehensive bloodless program. Orthopaedic surgeries also often require blood transfusions. “We have established a bloodless program here at Georgetown primarily after having discussions with the Jehovah’s Witness community. They have a large population here in DC and have often had trouble obtaining medical services because of their religious belief in refusing blood transfusions. The purpose of our program is to reduce or eliminate the routine use of transfusion in surgical procedures. The result really benefits all of our patients, regardless of their religious convictions. Over the past 15 years studies have shown that some of the different benchmarks we’ve been using for giving a blood transfusion were too high. We now have compelling evidence that it is safe to allow the patient to recover at a lower blood level. They tend to have fewer complications and there is a medical benefit to not transfusing patients as liberally as we had in the past. “

How is bloodless medicine practiced? Dr. Zawadsky says there are three primary approaches: before, during and after surgery. “Before surgery we can give medications like iron supplements or EPO protein to boost the blood’s hemoglobin level. That helps if the patient is anemic. During surgery we are as precise as we can be with surgical technique to limit blood loss; we keep the patient warm with warming blankets which keeps blood loss down. There are anesthesia techniques to lower the blood pressure so patients bleed less. There is also a machine called Cell Saver that we use during surgery which collects the blood lost, suctions it into a canister, washes and filters it and then returns it directly into the patient as a product that is about 60-percent pure red blood cells. After surgery we can use medications to raise blood levels and we avoid taking multiple blood draws for blood tests. It’s really a focus on how much blood the patient is losing with the goal of reducing or avoiding the use of blood transfusions,” Dr. Zawadsky said.

Ms. Lee had a procedure called isovolemic hemodilution to minimize the loss of red blood cells during surgery. Hemodilution is performed by removing anywhere from one half to two liters of the patient’s blood while they’re asleep before surgery begins. That amount of blood is then replaced with a fluid like saline to maintain the blood volume during surgery so if there is bleeding, there is less loss of red blood cells. Afterwards, the blood removed before the surgery is then put back into the patient, a process that then boosts the patient’s red cell count.

Ms. Lee is now back enjoying her regular life. “I am once again able to take care of my mother, visit friends and enjoy my work with the deaf community in my church.”

Dr. Zawadsky performed a total knee replacement on Theresa Mack, 58, of District Heights, Maryland. Ms. Mack is a Jehovah’s Witness and also wanted surgery without a blood transfusion. “I was in so much pain with my knee before this surgery. Dr. Zawadsky was very cognizant of my religious beliefs; he was great. He did everything I had asked regarding taking in blood. I am so glad I was able to have this done in a way that honored my religious beliefs. I couldn’t have done it otherwise.”

“Ms Mack received medication to treat her anemia before surgery, we used some surgical techniques to help clotting in the wound during surgery and slow down blood loss after surgery, and we limited the number of times we had to draw her blood for testing after surgery. She did very well.”

The Bloodless Medicine and Surgery program is open to anyone who wishes to avoid a blood transfusion. In June of 2011 Milca Francisco Ford of Silver Spring, Maryland went through the bloodless medicine program for her mastectomy at Georgetown. “The program is wonderful. I had so many friends and co-workers who were making me feel ridiculous for not wanting to agree to a blood transfusion. It was nice to have people who understood how I felt and were willing to work with me. They explained everything to me and evaluated me. For me, I just didn’t feel comfortable having a blood transfusion.”

“The blood supply is safer than it’s ever been,” said Dr. Zawadsky. “But there are still risks of disease transmission; the risks are small, but not zero. That’s why we see this as good medicine. Studies have shown a benefit when there is a priority on reducing blood transfusions and all patients can benefit from that.”

“This really is about treating the whole patient—physically and spiritually,” Dr. Evans added. “And while there is a large group of people in the area who request blood conservation methods for religious reasons, no one wants to have a blood transfusion. We know that blood conserving techniques help shorten hospital stays, reduce the risk of contamination and decrease the cost of care. They are a win, win for everyone.”

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