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Bloodless Strategies

Techniques

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBO) is a medical treatment in which patients inhale 100% oxygen in a total body chamber, under increased but controlled pressures. It is used for a wide variety of treatments, usually as a part of an overall medical care plan.

 Kelly Johnson-Arbor, MD
Meticulous Surgery

To avoid blood loss, meticulous and precise surgical technique remains the most important. By carefully following this total management approach and carefully adhering to sound surgical principles and techniques as suggested here, redo-cardiac surgery can be performed safely and successfully without blood transfusion.

 Manuel Estioko, MD
IV Iron Dextran Infusion Protocol

The following is the methodology I use for the administration of intravenous iron dextran, for total dose infusion.  I have used this method for more than thirty-five years and it has worked quite well, with uniformly safe outcomes.

 William Pogue, MD
Tolerating Low Hemoglobin

Fundamental physiological processes relevant to all types of anemia—the compensatory mechanisms that are triggered in the anemic patient.

 Stephen Selinger, MD

Case Reports

Life-threatening Postpartum Anemia in a Jehovah’s Witness

The management of Jehovah’s Witness patients with bleeding and severe anemia can be very challenging because of non-acceptance of ...

Angelina A. Gapay, MD
Maintenance of normal hematocrit in high-risk thyroid surgery without allogeneic blood transfusion: a case report

A 44-year-old woman presented at the Surgical Outpatient Department with anterior neck swelling of 4-year duration measuring 9 cm (vertical) ¥ 13 cm (transverse).

 Nathaniel Usoro, MD
Successful treatment of a Jehovah’s Witness Parturient with Placenta Accreta by a Multidisciplinary Team

The Jehovah's Witness surgical patient presents the surgeon and anesthesiologist with special medical and ethical considerations that arise from refusal of blood transfusion. There is great heterogeneity in blood product acceptance among antenatal patients of the Jehovah's Witness faith. Jehovah’s Witnesses represent 0.8% of the US population.

Sepideh Khalilian, MD
Total Knee Replacement: 65-Year-Old Male with Severe Osteoarthritis; Treatment Previously Refused at Another Hospital

Perioperative blood loss is a significant concern for patients undergoing total joint arthroplasty. A growing body of evidence has shown tranexamic acid...

Timothy Penn, MD
Successful management of profound anemia in upper GI bleed without blood transfusion: a case report.

Treating a 22-year-old male admitted with hemoglobin of 3.7, discharged from the hospital with a hemoglobin level of 7.6, and 10.3 within one week.

 Richard Verstraete, RN
Total Knee Replacement without Blood Transfusion–83-Year-Old Female with Kidney Disease

A growing body of evidence has shown tranexamic acid (TXA) to be effective in decreasing perioperative blood loss and transfusion requirements in both primary and revision hip and knee arthroplasty.

Timothy Penn, MD

Total Hip Replacement without Blood Transfusion: 53-Year-Old Male with Cardiac Arrhythmia

A growing body of evidence has shown tranexamic acid (TXA) to be effective in decreasing perioperative blood loss and transfusion requirements in both primary and revision hip and knee arthroplasty.

Timothy Penn, MD

Overviews

Bloodless Medicine and Surgery

Bloodless Medicine and Surgery (BMS) is the provision of quality health care to patients without the use of allogeneic blood with the aim of improving outcome and protecting patients’ rights.

 Nathaniel Usoro, MD
Optimizing Care: A Physician’s Perspective on Bloodless Medicine

Any hospital can practice bloodless medicine, as this area of medicine does not always need to involve advanced techniques, expensive equipment, or esoteric methods of patient care. In many cases, optimization of bloodless medicine patient care can be managed with a careful review of current medical practices.

 Kelly Johnson-Arbor, MD
Resources for Establishing a Bloodless Medicine and Surgery Program

This strategy page describes a BMS Program and how it meets the needs of patients seeking optimal medical care without the use of blood transfusion.

 Richard Verstraete, RN
Complications of Blood Transfusion

This strategy page focuses on the risks of blood transfusions and describes the body’s tolerance of anemia.

 Hiep Dao, MD
An Interview with Manuel R. Estioko, MD

MedStar Bloodless asked Dr. Estioko to elaborate on some key points in his report, Redo-Cardiac Surgery Without Blood Transfusion In Adult Jehovah’s Witness Patients. These are his replies:

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