Surgery without blood transfusion

Have you ever thought of legitimate and effective ways to manage serious medical problems such as surgery without using blood transfusion? Except for emergency surgeries, it is very possible to have major surgeries which usually require help of anaesthesia or respiratory assistance such as cardiac operation, bowel cavity operation, and reconstructive surgery done without transfusion.

Many people today reject blood transfusion for both health and religious reasons because although blood is screened before transfusion, there is 0.1 per cent a risk of infection says Dr Alex Mugalu, a surgeon at LifeLink Hospital. There has been research on alternatives to transfusion but the idea of bloodless surgeries was first advocated by Jehovah Witnesses, a religion that does not allow ingestion and transfusion of whole blood, red cells, white cells, platelets, or blood plasma.
Their belief permits them to accept surgeries and organ transplants only if done without blood transfusion. Many major surgeries have been done successfully without blood transfusion and if you have any doubts, *Maria Kalungi’s experience will put them at bay.

The experience
“In 2009, I developed pain in the chest and right shoulder. I thought it was an effect of typing since I do secretarial work. I took pain killers and the pain subsided but it became frequent and shifted to the upper abdomen. I used to do self-medication and thought I had ulcers. For six months I continued taking pain killers and massages but the relief they provided was short-lived. I then went to a clinic and was given intravenous diclofenac but the pain persisted. When the pain persisted, I sought medical attention.

I went to SAS clinic where the doctor recommended a scan test. I saw Dr Owori, a surgeon, who diagnosed me with gallstones. He explained that I had to choose between an operation where a small hole is cut and the stones removed or having an open cut. I opted for the open cut surgery because the other alternative was very expensive. The doctor administered strong pain killers and asked me to choose a day for the operation.
“When I told my mother, a Jehovah Witness, about my situation she said she had experienced a similar problem. She, however, cautioned me not accept blood transfusion during the operation. She made it feel like blood from another person is dirty. “It must be my own blood in my body,” she insisted. She gave me blood boosters (such as beetroot, liver, bean soup, boiled avocado leaves) the week before I checked into hospital for the surgery.

There was a big argument between my mother and husband on whether to be transfused or not. My mother believed I was going to be fine but my husband did not want to risk if there was an need.
The surgeon checked my blood level and noted my blood group. I believe he spared some blood just in case something wrong happened during the operation but I was not transfused and I got better.

However, in 2011, I got a tear in the rectum and the gynaecologist thought I had haemorrhoids. He sent me to a surgeon who said my problem would only be managed with an operation adding that I would be good to go in two days. I took the boosters like in the first operation and when I checked into hospital for the surgery, I was told it was going to be painful but I would be well after a few days.

I was taken to the theatre but I lost a lot of blood during the operation. My mother refused any blood transfusion. The surgeon then gave me an injection that stopped bleeding and when the surgeon checked on me the next day, I had an abscess and had to undergo another operation called Incision and drainage. After this, I got a mild fistula and had to use adult diapers. I had to go for another operation and was almost giving up on living. I was taken back to the theatre to “cut and scrap” because the surgeon was worried that my rectum was going to lose elasticity. My blood pressure dropped but mother still insisted that I should not get transfused. She supported and continued giving me the blood booster mixture.
After the third operation to clear the fistula, I could barely sit. My mother requested the hospital to take care of me outside the hospital setting since she is a nurse. I had weekly visits to the hospital and the wound healed.”

Preparation for surgery
Before an operation, a patient must have at least 10 grams per deci-liter of haemoglobin but for emergency cases, it can be 8g/dl. Other factors such as blood pressure, pulse and oxygen circulation must be normal.
Dr Mugalu says, “Preparation for surgery requires that one’s blood count (level) be taken, blood group noted and ensuring the haemo-dynamics (the fluid dynamics of blood flow) are at the required level. Your bleeding time, clotting time is also noted before operation. Blood must be transfused in case you have lost a lot that your body is unable to replace it.”

The options

Surgery is not always the only alternative. There are several therapeutic options that reduce on chances of blood transfusion. These involve clinical strategies with medicine, specific equipment depending on the capability of the hospital and the surgeon’s experience.
Dr Mugalu stresses that patient preparation is key in bloodless surgeries and ideal for non-emergency surgeries. He says the patient should be given food that is rich in iron such as red meat, liver, beetroot, bean soup and leafy vegetables in combination with fruits rich in Vitamin C. “The patient may also be given folic acid or iron supplements, Vitamin B12, and erythropoietin a growth factor that cause the bone marrow to make more blood cells,” he adds.

However, people with severe bone marrow disease may not respond to the erythropoietin (a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues) growth factors because they do not have enough blood-producing cells in their bone marrow.
Dr Mugalu also recommends autologous transfusion where the patient is given their own blood. He says, “The patient’s blood is taken from him before the operation and kept. This very blood is transfused to the patient in case he loses a lot of blood during the operation.”
Sometimes this lost blood can be saved by collecting it with a special machine called a Cell Saver and given back to the patient. This is recycling the patient’s blood.

“The surgeon can allow the patient to have their blood pressure a little lower, to a tolerated level. This will result in less blood loss, because the blood leaking pressure to outside the body during bleeding will be minor,” says Dr Mugalu.
There are intravenous medications that stop bleeding like Tranexamic acid, aminocaproic epsilon acid and others. Diathermy, a surgical technique which involves the production of heat in a part of the body to cause bleeding vessels to clot can also be used instead of a transfusion.
The surgeon would also use hemostats such as surgicel cellulose, heamostatic sponge, floseal, and thrombin, a coagulation factor.

What you ought to know
Advantages. Bloodless surgeries reduce the risk of infection from blood bone infections from another person’s blood. It reduces the recovery time and hospital stay. Unnecessary transfusions are avoided and blood is kept for people that critically need it for emergencies.
Faith matters. Jehovah’s Witnesses believe the Bible prohibits ingesting blood. Their belief is based on Genesis 9:4 which states: Only you shall not eat flesh with its life, that is, its blood.

Impact. This has led to medical, legal and spiritual arguments and their contribution towards research on blood transfusion alternatives.
in an article ‘Quality Alternatives to Transfusion’ it is mentioned that, “The conscience of some Witnesses permits them to accept organ transplants if done without blood. A report of 13 kidney transplants concluded: “The overall results suggest that renal transplantation can be safely and efficaciously applied to most Jehovah’s Witnesses.”

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