PeaceHealth Southwest addresses those who refuse blood transfusions

By Marissa Harshman, Columbian health reporter

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PeaceHealth Southwest Medical Center is holding a community workshop on its blood conservation program. The event begins at 6 p.m. Feb. 13 at the hospital’s Health Education Center, 400 N.E. Mother Joseph Place. For more information about the program, visit http://www.swmedicalcenter.com/bloodconservation.

When Brenda Jordan awoke from her medically induced coma, she was devastated.

While unconsciousness, Jordan dreamt she had a blood transfusion. For the Jehovah’s Witness, a transfusion would mean she defied God’s command to abstain from blood.

Jordan discovered three days later, when she was finally able to speak, that she had not received a transfusion. It was just a dream.

“It was such a relief,” Jordan, 53, said.

And several months later, when the Vancouver woman had open-heart surgery in November, she did so without putting another person’s blood into her body.

Jordan’s transfusion-free surgery was possible because of a new blood conservation program at PeaceHealth Southwest Medical Center in Vancouver.

In July 2009, hospital administrators started looking into why local residents were seeking medical care from out-of-town hospitals. The staff identified a big need for services for patients who don’t want transfusions, whether for religious or other reasons, said April Ching, blood conservation specialist for the hospital.

“Our hospital was not known for treating patients who didn’t want blood transfusions,” she said. “So patients were seeking care elsewhere instead.”

So the hospital launched its blood conservation program and, in September 2010, the medical center started offering bloodless surgeries, Ching said.

In the first few months of the program in 2010, hospital staff saw 16 patients. But one year into the program, the hospital saw 147 patients in one month, November 2011.

Today, 31 physicians participate in the program, representing a range of specialties including general surgery, anesthesia, orthopedics, urology and gynecology oncology.

Dr. Steve Matous, a general surgeon, said a transfusion-free procedure doesn’t look much different than a typical procedure. The main difference, he said, is surgeons are extra diligent about stopping bleeding, treating every drop of blood as precious.

The surgeons use a variety of blood-saving techniques and equipment to prevent blood loss. One method used during surgery

requires a machine called the Cell Saver.

Surgery staff use a suction device -- much like the device dentists use -- to remove blood from the surgery area. The blood is mixed with saline and medication to prevent clotting. The blood travels through tubing into a chamber where its filtered and cleaned. The clean red blood cells can then be returned to the patient’s body or saved should the patient need it later, said Jack Som, registered nurse and surgical nurse specialist for general surgery.

While most general surgery procedures don’t usually require blood transfusions, other surgeries -- like open-heart and liver surgeries -- usually require transfusions. A typical open-heart surgery, for example, could require four or five units of blood, Som said.

The Cell Saver machine, however, reduces the need.

“This is better for patients because they’re getting their own blood back,” Som said.

Other blood-saving techniques include cauterizing the blood vessels while making incisions to prevent bleeding, and using diet and supplements to enhance red blood cell count before surgery, Ching said.

Surgeons can also remove blood rich with red cells and inject saline. Then the patient loses diluted blood that can be replaced with the richer blood, Matous said.

The blood-saving techniques and the conservation program require physicians who are willing to think outside of the box and try new things, he said.

“There is a subset of people in America that under no circumstance want blood transfusions,” Matous said. “That has put doctors in this ethical dilemma for a while.”

The program has given doctors an alternative to the traditional options: do surgery without transfusions and hope the patient doesn’t lose too much blood or refuse to operate, he said.

The program has also given patients like Jordan peace of mind.

Jordan filled out her medical directive prior to the heart attack that landed her in the hospital. Jehovah’s Witnesses often carry that medical directive so, in the event of an emergency, their decision to not receive blood transfusions under any circumstances is clear.

Even with the directive, Jordan said, she and others with similar beliefs have to hope providers find the paperwork and respect their wishes if they are unconscious.

The blood conservation program records patients’ wishes in the hospital computer system, even before they need a procedure. That extra notification has a calming effect, Jordan said.

“It’s just comforting to be able to put your life in the hands of people that will respect your wishes,” she said.