Giving The Gift of Life

You know you're in serious medical distress when you're being transfused with life-saving blood plasma. And you thank heavens for that life-saving intervention, because most of us fervently plan to continue living and appreciate the opportunity that medical science allows us through this simple medium to overcome whatever dire medical condition has arisen to make this transaction between blood services and patient need possible.

blood transfusion. (Image by ShutterStock) 

 

But now, as always, medical science has been given reason to second-guess itself. Astute vigilance to the best possible patient outcomes, the realization that perhaps blood transfusions should be given under certain circumstances and not others driven by observations that appear to credibly suggest that patients, for the most part, recover better and faster, have fewer infections, and their internal organs less deleteriously affected by the process points to caution.

Now, it has become more common during surgery that blood draining out from wounds be siphoned off for reprocessing and reinfusion into the patient. Drugs are being used more aggressively to prevent bleeding and improve blood clotting. Surgery with the use of laparoscope techniques and other such less invasive minimalist tools reduce bleeding from large surgical wounds. Screening for anemia and treatment with supplements or drugs to boost bone marrow for blood production is becoming more commonplace.

All to provide better medical care in hospitals, and to avoid, if at all possible, the unnecessary use of blood transfusion. Research being assembled and studied appears to validate suspicion among critical care specialists that blood transfusions may be linked to increased risks relating to post-surgery infections, cardiac arrest, heart attack, stroke kidney failure, lung injury, multi-organ failure and ultimately death.

Pretty sobering. Who might have imagined that the most common expedient to aid medical conditions so heavily relied on for so long, might be causing additional, and very serious medical problems? The very problem of intervention of this type potentially being the cause of other more serious events. The Russian philosopher, Ivan Illich, a dozen years ago proposed that treatment rather than being a cure, sometimes resulted in an iatrogenic response.

It can be seen in the use of prescription drugs which, while purporting to solve one medical dilemma, can have offshoot effects, disturbing consequences that can occasionally bring on other maladies, some of which are more serious than the original one the drug was meant to alleviate. In the case of blood transfusions the American Medical Association has identified the procedure as being among the top five overused procedures in medicine.

Research appears to point out that even under circumstances when patients suffer from the very identical condition, the same surgery takes place along with predictable blood loss, transfusion rates vary from hospital to hospital. Relevant standards do not appear to exist as professional guidance for medical practitioners. A study of over 8,000 surgery patients in British Columbia over a two-year period found transfusion rates to vary from 35 to 66%.

An audit of Ontario hospitals concludes that close to one in three transfusions of frozen plasma were unnecessary. Knee replacement patients in Calgary are transfused at rates from two to 25%; it all depends on the surgeon and his/her techniques. If multiple units of blood are transfused the risk of fluid overload increases; extra blood overwhelming the heart's ability to pump it throughout the body. One of the leading causes of transfusion-related death.

"The biggest challenge is trying to change the behaviour of physicians. People are being transfused at hemoglobin levels higher than they need to be", advises Dr. Alan Tinmouth, a hematologist and scientist at The Ottawa Hospital Research Institute. Again, studies demonstrate that the more blood given, the more critical the outcome. Transfused patients are twice as likely to develop infections, multi-organ failure and acute respiratory distress.

Not all doctors are convinced, however. Though prudence should be the keyword. Doubting doctors point out, reasonably enough, that none of the studies whose findings suggest increased harm risks prove cause-and-effect. Merely an association. And they point out as well that patients who require transfusion to begin with tend to be more health-impaired; little wonder their recovery is slower, that they experience more troubling and dangerous health impairments.

Time, most certainly, will tell, we hope and trust.