Bloodless surgeries gain favor

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Sunday, December 16, 2001 Las Vegas Review-Journal Bloodless surgeries gain favor Patients who want to avoid transfusions opting for procedure By JOELLE BABULA REVIEW-JOURNAL Profusionist Dale Appel monitors the cell-saver transfusion system while Dr. Hazem Afifi performs open heart surgery at University Medical Center on Friday morning. The system filters the patient's blood and pumps it back into the body. Photo by Gary Thompson. Heart surgeon Dr. Hazem Afifi uses a tube to suck up blood from the open chest of his patient during bypass surgery. Nurses then twist bloody gauze into tight ropes to wring precious blood into a bowl. The more blood that can be collected from patient Raul Sanchez during surgery, the better. The saved drops are then cleaned and filtered by a machine and pumped back into Sanchez's body, reducing the need for a donated blood transfusion. To meet the demands of patients who either fear getting a disease through donated blood or refuse transfusions for religious reasons, local hospitals are offering some patients the chance to recycle their own blood during surgery. Local concerns over using donated blood mimic national ones, as patients across the country seek bloodless alternatives. "A transfusion is sometimes undesirable because of reactions to the blood or the risk of contracting HIV or hepatitis," Afifi said. "It's better to give the patient back as much of their own blood as you can." The risk of contracting HIV through a blood donation is "extremely low," according to the Centers for Disease Control and Prevention. Most people infected with HIV through a transfusion received the blood before 1985, the year HIV testing began for all donated blood. "An estimated 1 in 450,000 to 1 in 660,000 donations per year are infected with HIV but are not detected by current antibody tests," according to CDC literature. Still, 17 adults and two children have contracted AIDS through a blood transfusion or the receipt of other tissue products in Clark County since 1992, according to HIV and AIDS statistics from the county health district. Sanchez, 74, had his blood collected and recycled during coronary artery bypass surgery Friday morning at University Medical Center. The collected blood was drawn into a cell-saving machine at the foot of his bed, where blood cells were separated from plasma and washed with saline before being pumped back into the body. "If patients ask for this procedure, we give it to them as long as they are a good candidate for it," said profusionist Chuck White, who often operates the cell-saving machine as well as heart, lung and bypass machines at several Las Vegas hospitals. About 90 percent of University Medical Center's heart surgery patients are hooked up to the cell-saver, White said. Aside from the heart patients, about five bloodless surgeries are performed daily at the medical center, he said. The cell-saving machine can be used on other procedures in which a lot of blood is lost, such as knee or hip surgeries. It can also be used for different surgeries on pregnant women, or on emergency trauma patients when donated blood is scarce. "In the past, the blood was just shed and thrown away," White said. "But now we realize that by washing it with saline, we can actually clean the cells and give them back to the patient." Although the cell-saver machine and other bloodless procedures have been used nationwide for the past decade, it's only been in the past two years that more patients have become aware of such alternatives and are asking for them. "Many surgeons will bring up the procedure before surgery and most patients will choose it," said Dr. Brad Karon, medical director of transfusion service at Sunrise Hospital and Medical Center. The idea of a complete bloodless surgery center at Sunrise has been batted around at committee meetings, but there are no preliminary plans in place, Karon said Friday. He also said it's more likely the hospital will develop a formal system for registering patients who don't want a transfusion, rather than instituting a complete new center. Bloodless surgeries, including the cell-saving procedure, also provide an alternative to those who refuse transfusions for religious reasons. Many Jehovah's Witnesses refuse blood transfusions because blood is viewed as sacred and the Bible mandates no transfusions, said Al Zaragoza, chairman of the hospital liaison committee for Jehovah's Witnesses. "A cell-saver is an extension of one's circulatory system," Zaragoza said. "It is permissible, but it's still a personal choice."