Bloodless Medicine and Surgery: Top 10 Things To Consider

[Guest Nicole]

Bloodless medical care seeks to avoid the need for transfusions. The following is a review of the most important considerations for setting up a bloodless care center.

“Bloodless” medical care was first recognized in the 1970s when Denton Cooley, MD, performed cardiac surgery on hundreds of patients who were Jehovah’s Witnesses (JW).1 These patients were often turned away by other physicians because they were prohibited from receiving allogeneic transfusions. Bloodless care became more common in the 1980s, when the risks for viral infections transmitted through transfusion reached an all-time high, especially for HIV and viral hepatitis. The practice of bloodless medicine was further developed and promoted by the Society for the Advancement of Blood Management (SABM), which was founded in 2001 and continues to specialize in this area today.

Bloodless care shares many principles in common with “patient blood management” (PBM),2 which aims to prevent and manage anemia, optimize coagulation to reduce or prevent hemorrhage, and promote optimal blood conservation, and to achieve these goals in order to improve outcomes with an evidence-based, patient-centered focus.3 PBM was an outgrowth of multiple randomized clinical trials, all of which compared a restrictive with a liberal transfusion strategy based on hemoglobin (Hb) triggers of 7 to 8 versus 9 to 10 g/dL, respectively, in which every trial showed either no benefit from or increased adverse outcomes with the liberal strategy.4-11 Perhaps these trigger trials were a natural progression from the high prevalence of viral risk that emerged in the blood supply during the 1980s or were efforts to reduce other transfusion-related risks and complications. Nonetheless, it is now generally accepted that “less is more” when it comes to transfusion, with the exception of ischemic brain and ischemic heart syndromes, for which the ideal Hb trigger is yet to be determined.12 Bloodless care can be thought of as extreme PBM, in which the goal is to avoid rather than reduce the need for transfusions.

In this article, we will review the top 10 issues to consider when setting up a bloodless program, which are summarized in Table 1.

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