Need for Transfusion in Heart Surgery Questioned in Study
Jehovah’s Witnesses, whose faith forbids them from blood transfusions, recover from heart surgery faster and with fewer complications than those who do get blood, in a study that may change thinking on current practice.
Patients who are Jehovah’s Witnesses had better survival rates, shorter hospital stays, fewer additional operations for bleeding and spent fewer days in the intensive care unit than those who received blood transfusions during surgery, a study today in the Archives of Internal Medicine showed.
Members of the Jehovah’s Witness faith undergo extensive blood conservation before surgery, including red blood-cell boosting erythropoietin drugs, iron and B-complex vitamins to guard against anemia. The practice offered a “unique natural experiment” for scientists to study the short- and long-term effects of the blood management strategy and may point to ways to reduce need for transfusions, researchers said.
“How we care for Jehovah’s Witness patients with this pretty extreme blood conservation doesn’t put a patient at increased risk,” Colleen Koch, a study author and professor of anesthesiology at the Cleveland Clinic in Ohio, said today in a telephone interview. “Perhaps it needs to be examined more closely applying some of these practices to our routine cardiac surgery patients.”
Researchers in the study included 322 Jehovah’s Witness patients and 87,453 other patients who underwent heart surgery at the Cleveland Clinic from 1983 to 2011. All Jehovah’s Witness patients refused blood transfusions. In the other group, 38,467 didn’t receive transfusions while 48,986 did.
The authors wanted to look at the difference between patients who receive blood transfusions during surgery and Jehovah’s Witness patients, who undergo strict blood conservation practices before, during and after surgery, Koch said.
While many patients don’t have blood transfusions during and after heart surgery, they also don’t undergo the same blood conservation practices that doctors use for Jehovah’s Witness patients, she said.
The study found that Jehovah’s Witnesses had lower occurrences of heart attack following surgery and less need for prolonged ventilation. Jehovah’s Witness patients had an 86 percent chance of survival at five years and a 34 percent chance of survival 20 years after surgery, compared with 74 percent at five years and 23 percent at 20 years for non-Jehovah’s Witness patients who had transfusions.
Victor Ferraris, who wrote an accompanying editorial in the journal, said doctors can do many things before and during surgery to conserve blood and prevent the need for a transfusion.
He said for some procedures, instead of patients being placed on a heart-lung machine, which takes over the operations of the heart and lungs during surgery, doctors may want to consider performing the operation while the heart is still beating to reduce the risk of bleeding and the need for transfusions. Patients can also be given drugs to help reduce their risk of bleeding.
“The question to ask is why don’t they do that for everybody,” said Ferraris, a professor of surgery at the University of Kentucky in Lexington, in a June 29 telephone interview. “We’ve proven we can do really good blood conservation and maybe we should expand this to a broader audience and really focus on limiting bleeding and blood transfusion.”
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