Articles

History of Bloodless Medicine and Surgery


Summary

This introductory module walks learners through the history of bloodless medicine and surgery and identifies key factors that led to the growth of the bloodless approach.

These Continuing Education (CE) accredited introductory modules walk learners through the history of bloodless medicine and surgery (BMS); identify key factors that led to the growth of the bloodless approach; outline strategies that ensure patient safety and well-being; and discuss legal and ethical concerns related to BMS. The intended audience for these modules are healthcare providers and administrators throughout the world who are interested in learning about the care of patients who decline blood transfusion.

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Transcript

Bloodless Medicine and Surgery, MedStar International Training Center for Bloodless Medicine, Bloodless Medicine, Evidence-based Strategies, Safe Treatment Without Transfusion, Medication, Surgical/Anesthesia Techniques, Strategic Planning, Minimize Blood Loss, Optimize Tissue Oxygenation, Manage Anemia, Goal of bloodless approach is to optimize care when transfusion is NOT an option

What is Bloodless Medicine and Surgery?

Bloodless medicine is a set of evidence-based strategies that enable healthcare providers to treat patients safely and effectively without the transfusion of allogeneic whole blood or its primary components. Instead, the focus is on using medication, surgical and anesthesia techniques, and strategic planning to support the three pillars of bloodless medicine: minimizing blood loss; optimizing tissue oxygenation; and managing anemia. We’ll talk more about the three pillars later in the module.  

It’s important to remember that the goal of the bloodless approach is to optimize care when transfusion is not an option.

Let’s talk about how this need arose.

History of Bloodless Medicine and Surgery

Leading up to the 1940s, scientific advances in collecting, matching, and storing blood aided the rapid development and acceptance of blood transfusion. And after extensive use in World War II, transfusion became entrenched in medical practice. This conflicted with the religious views of Jehovah’s Witnesses, who believe that giving or receiving a transfusion of blood is as unacceptable as consuming it.  

Witnesses rejected transfusion as the standard of care, and their refusal was initially met with little understanding in the medical community. Very few clinicians were willing to treat these patients, and as a result, they didn’t receive the same level of care as those who accepted transfusion. This led representatives of the Witness community to reach out to and collaborate with sympathetic physicians to find solutions for their optimal care.   

Over time, as these efforts led to peer-reviewed, evidence-based studies that showed the efficacy of bloodless strategies, this new approach began to be recognized as beneficial for both Witnesses and the general population alike. Let’s take a look at a few of the most consequential factors that led to its gradual adoption and growth.  

Is blood transfusion likely to help patients heal more quickly after surgery?

Growth of Bloodless Medicine and Surgery

Consider the following question: Is blood transfusion likely to help patients heal more quickly after surgery?

Risks of Blood Transfusion

Risk of type mismatch, contamination, disease transmission, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), immunosuppression, acute kidney injury (AKI)

Reactive vs. proactive approach to medicine

Risks of Transfusion

There are also many risks associated with blood transfusion. Many clinicians now view transfusion as a reactive approach and argue that medicine must aim to be proactive, leading them to be more open to finding avenues of care that don’t involve transfusion.

Clinicians can safely treat patients without blood transfusion. Bloodless strategies can have several significant advantages:

  • Fewer complications and faster recovery times
  • Lower mortality rates
  • Reduced hospital costs

Safety and Efficacy of Bloodless Medicine

Through the years, studies have shown that clinicians can safely treat patients without the use of blood transfusion. In fact, bloodless strategies can have several significant advantages, including fewer complications and faster recovery times, lower mortality rates, and reduced hospital costs.

Changing legal atmosphere in 1980s and 90s facilitated growth of BMS. Individual court cases were pivotal in reinforcing—and expanding upon—idea of a patient’s bodily rights. Push in medical community to put patients’ wishes at forefront of care

Emphasis on Patient Rights and Choice

The changing legal atmosphere in the 1980s and 90s also facilitated the growth of bloodless medicine and surgery. Individual court cases were pivotal in reinforcing—and expanding upon—the idea of a patient’s bodily rights, and there has been a great push in the medical community to put patients’ wishes at the forefront of care.   

Recap: Growth of BMS

As a result of these medical and legal advances, hospitals began to develop formal programs in bloodless medicine and surgery, and clinicians became more innovative in their approach to treating bloodless patients. Let’s hear more about this from Dr. Steve Evans, chief medical officer for MedStar Health.  

Dr. Stephen Evans

Chief Medical Officer, MedStar Health

I think in the United States the focus was very much physician-centered and not patient-centered. And that wasn’t out of self-serving needs; it was simply that most of the decision-making was unidirectional: from physician to patient. I think now everyone clearly understands the value of shared decision-making between a patient and the physician, and understanding and recognizing that I think is critically important to Jehovah’s Witnesses but I think to all patients in understanding their needs and their desires.

I think the second thing that’s happened in the last decade and more is the clear understanding of the evidence that now supports the outcomes that are significantly better when you do not use blood and transfusions in managing patients. The data is now overwhelming that restricting blood use in hospitalized patients has a positive impact on their overall outcome and survival coming out of a hospital. And I think those two pieces put a large spotlight on why it is so critically important to serve the needs of the Witness community. In the non-Witness community, recognizing that not using blood and using blood management processes to make sure that we can actually give them optimal care is a big deal. It clearly improves their outcomes as well. And so to be able to build and expand a toolbox to manage the Witness community not only benefits them, it benefits all of our patients in our healthcare system.

I think the future of bloodless medicine is probably going to be one of the most exciting areas in medicine in the next fifty years. So if you’re a scientist and focused in this area, it will be incredible. If you’re a practitioner, the practice of medicine will change significantly in operating rooms and in intensive care units. If you said as a medical student, “Gosh, I’m interested in bloodless,” I’d look at them and say, “Why wouldn’t you be? It’s going to be an incredible run.”  

MedStar International Training Center for Bloodless Medicine

We offer free consulting services for administrators and physician leaders wishing to establish a bloodless medicine and surgery program.
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