"It has been available to patients who refused a transfusion due to religious convictions, but most of the general public is still unaware this option now exists for them as well," comments Charles R. Bridges, MD, ScD, Chief of Cardiothoracic Surgery at Pennsylvania Hospital and Associate Professor of Surgery at the University of Pennsylvania School of Medicine.
"Traditionally, heart surgery is associated with the greatest blood loss of all surgical procedures so it is a technological challenge to routinely perform open-heart surgery without a transfusion. But we have a unique combination of skills and a coordinated team that is not commonly available elsewhere. We have the infrastructure in place to perform these bloodless surgeries often and well," states Bridges. "Not everyone will be a good candidate for this type of surgery, but I do predict that if patients meet certain criteria, more than 90% of them will be able to undergo heart surgery without receiving a blood transfusion."
PREPPING YOUR OWN BLOOD…
Before surgery, patients see Patricia Ford, MD, a Hematologist and Director of the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital, which is certified as a national bloodless center. She works with patients to prepare their blood for this option. Ford adds, "We work with our surgical patients to make sure they're at their best positioning in terms of blood count, including their hemoglobin and platelets, for clotting purposes. We want to make sure their blood parameters are at their best for the surgery. We can give your body a drug that helps you to build up blood cells naturally, allowing your body to increase its blood by about one unit a week."
Ford further explains that the earlier she sees a patient, the better the chance of obtaining an optimum level for surgery. "We prefer to conduct a hemoglobin screening 3-4 weeks before elective surgery. This transfusion-free option lets you decrease your risk of side effects or adverse reactions, as well as keep the blood inside your own body at all times. You can build it up before the surgery and use the techniques to limit the blood you lose during surgery."
In traditional open-heart surgery, on average, one to two units of blood are used in a typical operation, but a patient could receive up to seven units. The patient often also receives up to four or more units of plasma and may receive six or twelve units of platelets.
"The beauty of this option, if you choose it for reasons other than religious convictions, is that if you have it done, you can still get a transfusion during surgery to save your life if it becomes medically necessary," states Bridges. "However, by and large, we predict we'd be able to get the vast majority of these patients through open-heart surgery without requiring any blood. The patient doesn't have to worry about contracting diseases that are transmitted through blood." Plus, Ford cautions that even if you store and use your own blood, there are blood storage issues. Blood cells don't carry oxygen as well, can become deformed, and then won't flow through your vessels as well once returned to the body. In the approach that Bridges and Ford use, your blood never leaves your body making clerical errors virtually impossible and making sure that every blood cell is working at full capacity at all times.
WHY PATIENTS ARE CHOOSING THIS OPTION…
Irv Shapiro didn't let anything slow him down, until his heart valve needed surgery last month. The 60-year-old Mt. Airy, PA resident -- who has been stepping onto airplanes for decades, traveling all over the world for his work as an architect -- wanted to get back on his feet again quickly. He chose to receive a transfusion-free, minimally invasive heart procedure to fix his heart valve.
Shapiro walked away, days later, with one small scar. His surgeon, Dr. Charles Bridges, was able to make a tiny incision on his chest and separate his ribs gently, avoiding the need to "crack" his chest. The incision is about two inches long, under the breast crease, making it almost impossible to detect even by other physicians.
"I never even thought of the bloodless surgery option until I had my initial meeting with Dr. Bridges and asked him, 'Should I give my own blood for the operation?' He explained the option and how it was done and it was almost that simple," said Shapiro. "It was one less thing to do. I didn't have to give any blood to begin with. I was already anxious about making this repair happen as quickly as possible. I didn't want a waiting period for the surgery. I thought, 'Why not give this a shot!'"
EDITOR'S NOTES:
Come view the special equipment and preparations necessary to be able to offer this transfusion-free cardiac surgery option. For example, during the surgery: we avoid using sponges; we do use pediatric tubing and a mini-bypass pump. To arrange this, or to schedule an interview with Drs. Charles Bridges or Patricia Ford, or a patient, please contact Susanne Hartman at 215-349-5964 or susanne.hartman@uphs.upenn.edu.
Benefits of transfusion-free cardiac surgery:
- Decreased length of stay (one day on average)/shorter recovery time.
- Overall cost savings.
- Reduction in certain adverse event rates such as renal failure, respiratory failure and death.
- Complete elimination of certain adverse events such as transfusion reactions like inflammatory response and clerical errors during transfusions.
- Avoidance of immunosuppression, when a donor's white blood cells alter your immune system and make you more susceptible.
For more information on the Center for Bloodless Medicine & Surgery at Pennsylvania Hospital: http://pennhealth.com/bloodless/
Charles Bridges, MD -- on-line bio: http://pennhealth.com/WagForm/MainPage.aspx?config=provider&P=PP&ID=883
Patricia Ford, MD -- on-line bio: http://pennhealth.com/Wagform/MainPage.aspx?config=provider&P=PP&ID=1078
PENN Medicine is a $2.9 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt of NIH research funds; and ranked #3 in the nation in U.S. News & World Report's most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.
The University of Pennsylvania Health System includes three hospitals [Hospital of the University of Pennsylvania, which is consistently ranked one of the nation's few "Honor Roll" hospitals by U.S. News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center]; a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home care and hospice.