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article image'Transfusion confusion' — Blood transfusions may endanger life

By Abigail Prendergast     Jul 14, 2013 in Science
The Jehovah's Witness faith has long been opposed to blood transfusions. Now, recent studies show that they may have known a few things most others didn't. At least to a degree.
The Christian sub-sect of Jehovah's Witnesses hold beliefs against blood transfusions, on the basis that others' blood may contain tainted elements — in other words, having belonged to those engaging in idol worship or "sexual immorality."
With that in mind, doctors at a hospital in New Jersey had "pioneered" a surgery program without the need for blood transfusions. According to the Vancouver Sun, the Witnesses who would sooner "choose death over a transfusion," not only had recovered as well as their non-Witness peers, but sometimes even better.
From suffering less complications following surgery, to less time spent on ventilators to shorter intensive care stays, those adhering to the faith have shown much less of a likelihood to require additional surgeries.
While experts are making the claim that there is nowhere near enough evidence outside of people losing large amounts of blood at one time to really make any distinction as to whether the Jehovah's Witnesses may be onto something or not. Although, an increasingly growing amount of research coincides with the beliefs of said religion, associating blood transfusions with infections from surgery, "cardiac arrest, heart attack, stroke, kidney failure, lung injury, multi-organ failure and [even] death."
Another issue facing blood transfers is, of course, the risk of getting diseases, such as HIV/AIDS and Hepatitis. Such a case happened in Canada 30 years ago: "tainted" blood had gotten 2,000 patients infected with HIV, along with an additional 30,000 getting Hepatitis C.
Up until the latter half of the 19th Century, diseases were treated by the removal of blood, rather than the infusion of it.
Tools such as lances and leeches were utilized to bleed out any diseased blood. This technique is known as "blood-letting," and had been utilized for upwards of 2,000 years up until nearing the advent of the 20th Century. Contrary to the modern world, where blood, a.k.a. the "gift of life," is seen as a cure that is near-magical.
"But it does not work like that," says pediatric critical care pioneer and Montreal University professor, Dr. Jacques Lacroix. Not to mention, blood transfusions were marked "as among the top five overused procedures in medicine," by the American Medical Association.
Canadian patients who received blood via transfusions had gotten it with red blood cell units reaching 850,000, while platelet doses topped out at 102,000 from 2011 to 2012.
Researchers in Canada are at the forefront of making the notion of "restrictive blood use" being more beneficial known worldwide.
However, since there no real way to tell who gets the blood, what is was transfused for or even if it had been used at all. Even with patients having the same condition and same surgeries in different hospitals, transfusion rates between them differ greatly.
Of course, there is also the issue of how much blood is needed, as opposed to how much is actually given. The average human body contains about five liters of blood, according to the Sun. People receiving transfusions normally have multiple units of blood at any given time, thus exposing them to the risks of drowning in the overload of fluid. Deaths linked to transfusions are most often caused by circulatory overload.
"We found that, if you give less blood, you do better," said Dr. Paul Hebert, a critical care specialist in Ottawa. "We think that's because many of the patients didn't need it in the first place."
Hebert, along with co-authors had looked into 19 trials that involved over 6,000 patients in order to make comparisons between higher hemoglobin thresholds in red blood cell transfusions against those of the lower variety.
What they found was "that patients could be transfused at hemoglobin levels of 70 or 80 grams per litre of blood without putting them at any increased risk for major complications such as pneumonia, stroke, infection, or death."
"I think you can reduce blood use in many settings by at least
half" by using the "lower thresholds," said Dr. Jeffrey Carson, of Robert Wood Johnson Medical School in New Brunswick, NJ's Rutgers University. Recently, a "review of blood transfusions at three Ontario hospitals found that the pre-transfusion hemoglobin levels were higher than the recommended thresholds for many patients."
British Columbia had established the premiere transfusion registry back in 1999, and is still one of the biggest in North America. Even so, some of the transfusion rates there have been declining since putting in place "a network of blood transfusion coordinators in 25 hospitals."
One of the program's strengths is the treatment of anemic patients before surgery. This is so doctors can "avoid having to transfuse them when they bleed," said Dr. John Freedman, of the University of Toronto.
The Ottawa Hospital is aiming to have a system that is completely computerized and capable of tracking who gets blood transfusions, what said patients' hemoglobin levels are at the time of transfusion and where the blood is and happens to be going to.
Even with all of this information to consider, experts are not quite ready to say farewell to blood transfusions altogether. While human beings may be capable of operating on low levels of hemoglobin, if they get too low, vital organs such as the brain can be starved of oxygen.
Hebert, who has personally witnessed those of the Jehovah's Witness faith perish due to their refusal for a blood transfusion, admits a sense of helplessness, but at the same time realizes that they are still entitled to their own beliefs.
"You can't force your values on someone else," he said.
Hebert also pointed out that what doctors need right now, more than anything, is more research and education in order to determine how much blood (if any) is needed for a transfusion, and how long they can safely wait to commence such a procedure.
"The problem is that we don't have the data," said Hebert. "In many cases, we just don't know."
More about transfusion confusion, Blood transfusions, Jehovah's Witness
 
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