Surgery That Doesn't Draw on the Blood Bank

With AIDS and hepatitis fears rising, more hospitals are adopting and advancing bloodless techniques

By David Shook

It used to be that a technique known as "bloodless surgery" was mainly used by Jehovah's Witnesses, whose faith doesn't allow them to receive donated blood. The procedure involves minimizing blood loss during cardiac and other surgery so patients can go under the knife without transfusions.

In recent years, however, the fear of contracting AIDS and hepatitis has given bloodless medicine a broader appeal. More than 80 hospitals worldwide now offer transfusion-free surgery, up from a handful 10 years ago. Hundreds more hospitals are embracing bits and pieces of the bloodless-medicine discipline -- relying on a combination of technologies to conserve surgical blood loss.

Some doctors now believe that minimizing blood loss is simply good medicine. "Some patients who receive blood have weakened immune systems," says Dr. Deborah Nagle, a surgeon at Philadelphia's Graduate Hospital. "No one is really sure why, but it's an observed phenomenon." Patients have responded favorably, too. Bloodless medicine now is being used as a marketing tool -- a plus for hospitals that offer expensive surgical procedures as the industry consolidates.


  "More hospitals are looking at this as a business initiative," says Randy Thomas, director of the bloodless medicine practice at the Philadelphia Graduate Hospital, part of Tenet Healthcare, a for-profit hospital chain with 28 bloodless-medicine centers nationwide. Thomas says 20% of his center's patients now choose bloodless surgery for nonreligious reasons.

Through clerical or other human errors "the patient can receive the wrong blood or test result," says Dr. Aryeh Shander, chief of critical-care medicine and anesthesiology at New Jersey's Englewood Hospital and Medical Center, a pioneer in bloodless surgery. "You have to remember that blood is not a drug -- it's an organ. Plus, the scarcity of blood is a factor in people's decision. There just isn't enough to go around right now."

How does the technique work? Doctors can take take any of several approaches or combinations of them. "We like to think of the patient as his or her own blood bank," Dr. Shander says. Before surgery, a hyperbaric chamber distributes high concentrations of oxygen into the blood so patients can better withstand the procedure. Some physicians also administer biotech drugs such as EPO to patients to stimulate their bone marrow to produce more red blood cells, avoiding the need for a transfusion. And during surgery, doctors use blood-cell salvage machines that recycle the blood a patient loses, collect it, clean it, and return it to the body. A device called the argon beam coagulator clots the blood to minimize loss.


  Doctors can also use an apparatus that cauterizes vessels and veins through heat to stop them from bleeding as well as a process called hemodilution that enhances the circulation of a patient's own blood through intravenous fluids. And surgeons use a special scalpel that vibrates while cutting to help the blood clot.

Whether or not bloodless surgery becomes widespread, many doctors believe the concept of limiting blood loss and avoiding transfusions will become far more common in medicine generally. During coronary-bypass surgery, for example, doctors often rely on a pump to temporarily replace the functions of the heart and lungs. But the machine can destroy blood cells and, in some circumstances, trigger a dangerous reaction called "whole body inflammation" in which the body activates a dangerously high concentration of white blood cells. For some patients, new techniques that minimize blood loss during coronary surgery also allow off-pump surgery with the heart still beating.

Actually, few of the technologies used in bloodless medicine are new, and surgeons can pick and choose among them. "These are all techniques the doctors use at their discretion," says Audrey Bingham, coordinator for bloodless medicine at Doctors Hospital in Dallas. But given the perceived risks of conventional surgery, the Jehovah's Witnesses' ideas could benefit patients of every religious persuasion.

Shook covers biotechnology issues for BusinessWeek Online. Follow The Biotech Beat every week, only on BW Online

Edited by Thane Peterson

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