Spread the Word: Transfusion is NOT a "Lifesaving Procedure."

It’s happened again: Still another study, this time out of Canada, proving beyond all doubt that blood transfusion is bad medicine. 

The February, 2017, World Journal of Urology contains the results of a nine-year study of bladder cancer patients who underwent a surgical procedure called radical cystectomy.

Of the 2,593 patients, 62% overall received blood transfusions. (In 2000, at the beginning of the study, it was 68%. By 2008 the number had dropped to 54%. So surgeons are slowly getting the message, but not fast enough.)

Here are the results of the study:

Transfused:                                                    Not transfused:

Average hospital stay:            11 days                                 9 days

Readmitted within 90 days:   38%                                      29%    

Mortality:                               11%                                      4%

And here’s the big one: Overall 5-year survival rate was 33% higher among those patients not transfused. And the cancer-specific survival rate was a whopping 39% higher among those who had bloodless surgery!

This is like the umpteenth study proving that blood transfusion is a terrible idea. Here are just a few recent examples:

• Blood Transfusions in Patients Undergoing PCI Linked With Adverse CVD Outcomes
• “Observational studies examining patient adverse outcomes associated with blood transfusion.” 
• Blood transfusions still overused and may do more harm than good in some patients
• Fewer transfusions means better patient outcomes, lower mortality
• Minimizing Transfusions to Reduce Cost, Improve Outcomes
• What’s behind the decline in blood transfusions?
• Critical Care Patients Benefit From Restrictive Transfusion Strategy

One study specific to Jehovah's Witness patients commented:  

“Jehovah’s Witnesses who refused blood transfusions while undergoing cardiac surgery were significantly less likely to need another operation for bleeding compared with non-Witnesses who were transfused. They were also less likely to suffer a post-op heart attack or kidney failure.”

 Can’t we, by now, safely assume that, what has been found to be true in these fields of surgery, is true in every field? 

 

Yet the same day this bladder cancer study came out, another  story was published about the new guidelines for surgeons when a patient refuses a transfusion. It was introduced with the line, 

“Blood transfusions are a common and often lifesaving procedure.”

 That article noted that doctors are frequently accused of having a God complex. Many of them cultivate an attitude of all-knowing, don’t-question-me superiority. It even has a name: it's called "paternalistic medicine." In some cases it’s ego. However, another reason they do this is simply time management: A time-and-motion study showed that, contrary to the picture of them painted by TV shows like Chicago Med, doctors spend less than one third of their time at work actually seeing patients. They spend more than two thirds of their time writing notes and filling out forms to satisfy the requirements of their institution and the insurance companies. That would make for terrible TV, wouldn't it? But if they encouraged questions from their patients they’d never get any work done.

Because of the intimidation factor, and considering the years they spent in medical school, plus what we assume must be hours of ongoing study, you may feel the doctor surely already knows anything you might be inclined to tell him. Not so.

Surgeons spend on average 4.4 hours a week reading medical journals. Less than 5 hours a week! I spend more time than that on Facebook. If you are a heart surgeon, how likely is it that you’re going to spend part of your precious reading time perusing the “World Journal of Urology”?

Of course, as the list above shows, there have been articles in heart surgery journals, too, about the advantages of bloodless surgery, just as there have been in nearly every other field, from journals about joint replacement to journals about emergency medicine.

But changing the thinking of doctors is a slow process. As cardiothoracic specialist Bruce Spiess even went so far as to say:

"Blood transfusions are a religion. They have never been safety- or efficacy-tested," he said. "Drug options are carefully tested and regulated through prospective, randomised double-blind testing, but blood transfusion stands apart in that it has predominantly been believed to be helpful and evolved as a pillar of modern medicine."

Blood transfusions are not life-saving. They are simply bad medicine. Click on the links, do your research. Share this column with everyone you know, particularly if they are in the medical field or the media. 

Unlike those drug commercials, I'm not suggesting you "ask your doctor." I'm suggesting you "TELL your doctor." If he disagrees, find a doctor who has read something other than Facebook this week. 

To read another of my columns about blood medicine, click here.

 Bill K. Underwood is a freelance columnist and author of several books, all available in ebook or paperback at Amazon.com. You can help support this site by purchasing a book.

You Must Know about TXA Before Your Next Operation

A new study out of Baylor College of Medicine in Houston shows that use of effective anti-bleeding drugs during surgery is up. That's good. But it is not up enough. 

Dr. Henry Huang says:

“There is a growing body of literature to support the use of antifibrinolytics to decrease perioperative blood loss, so the hope was that utilization rate would come up, and it did so in our study. But nearly 30% of centers have still decided not to use antifibrinolytics despite the increasing evidence.”

Antifibrinolytics are drugs such as TXA (tranexamic acid) that promote clotting.

A huge study of TXA in 2012 called CRASH-2 looked at 20,000 patients (half given TXA, half a placebo). It proved beyond all doubt that doctors' most common fear about TXA - that it would cause patients to throw a dangerous clot - were absolutely groundless. (Remember that term - CRASH-2. Ask your doctor if he is familiar with the CRASH-2 study.)

30% of surgical teams not using TXA, or something similar, is a concern. What has inhibited the adoption of what is essentially a miracle drug?

Of the centers that did not use antifibrinolytics, two factors were predominantly cited: 1., surgeon preference, and 2., concerns about side effects.

Since CRASH-2 proved beyond doubt that the side effects were minimal, what's the remaining hold up? "Surgeon preference."

Really????

Take a card, write "TXA" on it in large letters, and keep it in your wallet. If you need surgery, pull it out. If your surgeon has a "preference" for blood transfusion instead of preventing blood loss, perhaps you should "prefer" another surgeon.

I've written quite a bit about blood medicine. To read my other columns on this subject, click here.

Please feel free to leave a comment. 

Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com.You can help support this site by purchasing one of his books.

TXA drug found to dramatically reduce blood loss

A DRUG that prevents ­patients from losing excessive amounts of blood during and after surgery dramatically reduces complications, a global trial led by The Alfred hospital has revealed.

In a study out of Australia, about 40 per cent of patients who have open-heart ­surgery need blood transfusions and emergency surgery to stem the bleeding, putting them at risk of worse outcomes.

But giving them the drug tranexamic acid (TXA) cut those complications nearly in half.

Anaesthetists and surgeons leading the study say the drug can be used safely for everything from heart surgery to hip replacement.

Melbourne researchers are also hopeful it will prove to be an effective “roadside drug” that reduces bleeding in trauma patients while they are being transported to hospital.

Doctors were concerned the drug’s tendency to promote clotting might raise the risk of heart attack or stroke. But Associate Professor Silvana Marasco, a cardiothoracic surgeon at The Alfred and co-author of the study,­ said the findings of the 10-year trial of more than 4000 patients found no evidence to support these fears.

She said excessive bleeding in surgery could reduce the ­patient’s recovery and increase costs to the health system because of blood transfusions and emergency surgery.

“Bleeding during a surgery prolongs it, but it also causes a problem when the patient continues to bleed after you close the chest,” she said.

“If they have ongoing bleeding, you have to give them a blood transfusion, and sometimes the amount of blood they lose can collect around the heart and actually compress the heart and stop it from working ­properly. In that situation, they ­become quite unstable and you are rushing them back to the operating theatre for emergency surgery and we have to reopen them, find where the bleeding is coming from and give them drugs to reduce it.”

Professor Paul Myles, director of anaesthesia and perioperative medicine at The Alfred, said the findings meant almost every heart surgery patient could be treated with TXA.

“Use of TXA can also be safely expanded to prevent bleeding with other kinds of major surgery, such as knee and hip replacements, trauma surgery and spinal surgery — operations where TXA is not much used at present,” he said.

The study, published in the New England Journal of Medicine, was funded by the Australian and New Zealand College of Anaesthetists and the ­National Health and Medical Research Council. [Read more here…]

To read another of my columns on blood medicine, click here.
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Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com. You can help support this site by purchasing one of his books.

Six more kids harmed by blood transfusion.

In yet another botched blood transfusion case, six Thalassemia-affected children were taken seriously ill after being transfused with blood at District Headquarters Hospital in Nayagarh district, India.

Similar incidents have been reported from Burla hospital and Balasore District Headquarters Hospital. Two patients at Burla had been given HIV positive and Hepatitis B positive blood, and a three year girl child had been given Hepatitis C blood.

India has been a mecca of “medical cruises” as American and other patients without adequate medical coverage found they could both vacation in India and have a hip replaced for less than the cost of their insurance deductible at home. But in just 2 recent years, over 2,200 patients in India contracted HIV from blood transfusions. 

If you are still of the mindset that your doctor knows best, you might want to educate yourself about blood medicine. You can start with a column I wrote about the safety, or rather lack thereof, of blood as medicine.

Feel free to leave a comment. To go to the home page, click here.  

Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com. You can help support this site by purchasing one of his books.

Why Blood is Bad Emergency Medicine

While more and more hospitals are jumping on the bloodless medicine bandwagon, emergency medicine seems to be going the other direction. Paramedics in some locations are beginning to carry blood in their ambulances and helicopters. 

Nearly every medical benefit – or supposed benefit – of transfused blood can now be achieved by some other treatment, at less cost, and with fewer negative effects. So why is blood still being used?

I’m not a doctor. But I’ve written a lot about blood, and in the process I’ve learned a lot about blood medicine. The more I learn, the more appalled I am that doctors continue to consider blood transfusion an effective treatment – for anything. This brief column is intended to summarize what I’ve written previously.

You can read some of my other columns on the subject here: 

• Advances in Blood Medicine
• Blood Medicine, Part Two
• Blood Medicine, Part Three
• Real Advances in Blood Technology
• Blood, Medical Ethics, and the Bible
• Hyperbaric Oxygen Therapy for Massive Blood Loss

 As we discussed in the column Blood Medicine Part Two, it isn’t enough for the hemoglobin inside your red blood cells to absorb oxygen in the lungs. It also must let go of the oxygen when it gets to where it’s needed. Since oxygen is attracted to the iron molecules in hemoglobin, releasing it is easier said than done. One ingredient that plays a key role in the release of oxygen from hemoglobin is a blood chemical called DPG. Lowering of DPG makes oxygen ‘stick’ to the hemoglobin – not good.

Your blood pH must stay between 7.35 and 7.45 - always. A number outside that range will cause your body to stop all other functions until it has corrected its blood pH. Blood pH begins to fall in storage. Donated red blood cells are stored in a solution called ACD – acid-citrate-dextrose. ACD acidifies – lowers the pH of – the blood even more. The lower the pH, the ‘stickier’ the hemoglobin becomes. At 14 days, the pH of stored blood has fallen to 6.9. Since blood pH below 7.35 is considered an urgent problem, why does an emergency room doctor wants to give it to you?  

In one study of patients who received 3 units of blood in emergency operations, the conclusion was:

“In [an] acute situation, when the organism (that’s you) needs restoration of the oxygen releasing capacity within minutes, the resynthesis [of DPG in stored blood] is obviously insufficient.”

Put simply, a transfusion of stored blood is the last thing you want entering your body in an emergency.

Stored blood:

• Carries antigens unique to the donor that can kill the recipient.
• Potentially carries Zika, malaria, hepatitis, HIV, Covid and a dozen other diseases.
• Has a low pH, forcing the patient’s body to work to raise it back above 7.35.
• Contains a high percentage of dead and dying cells that add to the workload of the patient’s organs.
• Contains inflexible red blood cells that cause clots.
• Contains potassium at levels 4 times higher than are considered healthy
• Contains ammonia at up to 10 times the upper limit of what is considered safe.
• Contains free hemoglobin that steals oxygen from the patient and adds to the workload of the liver.
• Is deficient in DPG, lowering the patient’s cellular oxygenation.
• Is deficient in nitric oxide, lowering capillary dilation, causing reduced cellular oxygenation as well as clots.
• Contains anti-coagulants - something not needed by an already bleeding patient.
• Raises blood pressure, straining and destroying fragile clots the body is trying to form at the wound site, increasing bleeding.
• Suppresses the patient’s immune system for, at best, days; at worst, permanently.  
  

 

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 Bill K. Underwood is the author of several novels and one non-fiction self-help book, all available at Amazon.com. You can help support this site by purchasing a book.

Hyperbaric Oxygen Therapy an effective treatment for massive blood loss

“In a famous experiment in 1960 published in the first edition of the Journal of

Cardiovascular Surgery Dr. Boerema of the Netherlands anesthetized pigs, removed nearly all of their blood, and replaced it with salt water while he compressed them to three atmospheres in a hyperbaric chamber. 

"At 3 ATA the pigs, with essentially no blood, were completely alive and well," he wrote. Dr. Boerema then removed the saline, replaced the blood, and brought the pigs to surface pressure where they remained alive and well. This phenomenon has been proven effective in other experiments and is the basis for clinical use in extreme blood loss anemia. 

"The best examples are Jehovah’s Witness patients who have lost massive amounts of blood and because of religious proscription are unable to receive blood transfusions," says Dr. Paul Harch. "These patients are kept alive over weeks with repetitive Hyperbaric Oxygen therapy until their blood system is able to naturally produce enough blood to sustain life.”

 

If your doctor is claiming that due to blood loss nothing but a blood transfusion will save your life, ask him/her if the facility has a hyperbaric chamber, or if they know where the nearest one is. Not every facility has one, but they've been around for decades. Just Google "HBOT near me".

 

To read my other columns about blood medicine, start here: 

 

Bill K. Underwood is a columnist and author of several books. You can support this page by following this link to his books at Amazon.com. 

Part 5: Blood, medical ethics, and the Bible

In a 2010 survey on ethics, 10,000 doctors were asked, ‘What was your biggest ethical dilemma?’

The top five were:

Blood Medicine, part three

 

 An operating room nurse responded to Part Two of this series:

“So you’re saying, if a woman in our birthing center is bleeding out, we should just let her die rather than give her blood?”

Are those really the only two options – blood transfusion or death?