'Bloodless' surgery avoids risks of transfusion

updated 7:39 p.m. ET April 24, 2006

PHILADELPHIA - When Irv Shapiro found out he needed surgery to fix a ruptured heart valve, one of the first questions he asked his doctor was whether he should donate his own blood.

He hoped to avoid being transfused with someone else's blood, but wasn't thrilled with the idea of spending weeks before surgery having pints of his own blood drawn and put in storage. So when he found out that Pennsylvania Hospital offered a third option — once only available to Jehovah's Witnesses — it was a relief.

"Not needing a blood transfusion, not having to get blood taken out of me, and a fast recovery time — I was OK with all of that," said Shapiro, 60, a founding partner of an architectural firm and heavy traveler.

Pennsylvania Hospital is now able to offer so-called "bloodless surgery" to 90 percent of its patients who want it, joining a small but growing number of bloodless medicine programs around the country that also serve the general public. Advocates put the number at about 120.

Many states have bloodless surgery centers or hospitals that perform no-transfusion surgery for Jehovah's Witnesses, who believe the Bible forbids transfusions, but not for the general public.

Some hospitals are now providing no-transfusion surgery to more patients because of advances in equipment and changes in protocols.

Bloodless surgery techniques vary depending on the type of operation, but can include efficient heart-lung bypass machines that circulate a patient's blood during surgery; using high-tech scalpels that clot the blood as they cut tissue; or freezing tissue before it's excised.

There is also pre-surgery planning. Doctors start seeing patients weeks before surgery to prepare.

Among the benefits are reductions in recovery time, hospital stay, cost and complications — as well as an estimated $20,000 in savings per patient, said Dr. Charles Bridges, the Pennsylvania Hospital cardiologist who performed Shapiro's surgery.

The general consensus in the medical community is that it is best to avoid donor blood transfusions whenever possible, but that transfusions remain an important lifesaving strategy. The American Medical Association endorses "autologous" blood transfusion — giving a patient his own blood — but takes no specific stance on no-transfusion surgery.

Pennsylvania Hospital has for at least a decade performed all kinds of no-transfusion surgery on Jehovah's Witnesses, Bridges said. In the year that no-transfusion heart surgery has been offered to patients, Bridges estimated that he has performed between 50 and 75 — up from about 10 just a few years earlier.

Heart surgery, because it is associated with extensive blood loss, is more difficult to do "bloodless" than other operations. In traditional open-heart surgery, a patient may need up to six units of red blood cells, four units of plasma and 10 units of platelets, according to the American Red Cross.

"People used to think of open-heart surgery as this draconian thing," Bridges said. "Now we have what really is a kinder, gentler open-heart surgery."

The best no-transfusion candidates typically are those needing only one procedure _ repair of a single heart valve or a single bypass, for example. It also can be done in more complex operations, however.

About six weeks after Shapiro's surgery to fix his damaged mitral valve, he was back at work part time.

"I feel very lucky that I was told about the transfusion-free option and that I was a perfect candidate for it," he said.

From pre- to post-surgery, the goal is conserving the patient's own blood, Bridges said.

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