Bloodless Medicine and Surgery
While receiving treatment at Moffitt, there may come a time when a blood transfusion or administration of a blood product is recommended by your healthcare provider. We strive to provide excellent care consistent with your faith as we develop your individualized care plan. This guide below is intended to stimulate a discussion between you and your provider. The entire team should understand and acknowledge your decisions, available options and associated risks.
We have included information regarding available blood products, alternatives and a brief explanation of each. We hope this will allow you to make an informed decision about your care with respect to your faith or personal wishes.
The following list of products is organized into "Usually Acceptable," "Personal Decision" and "Usually Unacceptable." Each decision will ultimately be up to you whether to accept or not accept.
Blood and/or Blood Components
|Hydroxyethyl starch, also known as Hetastarch, Pentastarch||A synthetic derivative of starch used as a plasma expander which improves circulation.|
|Erythropoietin Recombinant||Man-made version of erythropoietin. Used in the treatment of anemia and chronic kidney disease.|
|Factor VIIa Recombinant||A man-made protein that helps decrease bleeding.|
|Intravenous Iron||Delivering iron by infusion into a vein. Helps treat anemia due to blood loss.|
|Tranexamic Acid (Lysteda)
|Medication used to treat heavy bleeding during the menstrual cycle, nosebleeds, or procedures with heavy bleeding risk such as orthopedic surgery. Helps your blood to clot.|
|Desmopressin, Vitamin K||Chemical used to improve clotting.|
|Albumin Solutions||Similar to human plasma. Helps replace volume and blood loss. Made from proteins in human blood.|
|Autologous Pre-donation/Transfusion||Pre-operatively collects, stores, and then returns your own blood back to you.|
|Cell Salvage Intraoperative||Process by which blood from the surgical field is collected, filtered, and washed to transfuse back to you.|
|Clotting Factors, Plasma-derived, Concentrate||Proteins extracted from human plasma. Plasma is processed to separate the clotting factors. This makes a concentrate. Helps control heavy bleeding.|
|Epidural Blood Patch||A small volume of your blood is injected into the epidural space around the spinal canal. Used to stop leaking of cerebral spinal fluid.|
|Granulocyte Colony Stimulating Factor (G-CSF or GM-CSF)||Protein that stimulates the bone marrow to produce granulocytes (white blood cells) and stem cells.|
|Immunoglobulins||Proteins in blood serum that act as antibodies to fight infection.|
|Intraoperative Hemodilution||Blood conservation technique that reduces the amount of blood lost during surgery and replaces it with intravenous solutions.|
|Renal Dialysis (Hemodialysis)||Treatment that filters and purifies your blood using a machine. Excess toxins are removed.|
|Cryoprecipitate (personal choice)||Frozen blood product made from blood plasma. Helps control bleeding.|
|Red Blood Cells||Red blood cells made from whole blood by removing the plasma|
|Platelets (personal choice)||Small cells removed from blood that helps decrease bleeding by forming clots.|
|Plasma||Made from the liquid portion of whole blood. Contains clotting agents.|
|Stem Cells||Human cells found in many areas of your body. They can develop into different cell types and fix damaged tissue.|
On initial consultation with your surgeon, please inform your treatment team that you are interested in a Bloodless Surgery Pathway. Our pre-operative process will include:
- medical chart review
- questions about bleeding history
- previous surgeries and surgical complications
- current medication/herbal supplement use
- laboratory testing that may include obtaining your blood count, platelet count and coagulation profile
With this information, the team will collaborate to help determine a plan. You may be referred to visit a hematologist prior to surgery to optimize your blood counts and coagulation profile. If applicable, we will discuss pre-operative anemia and therapeutic options such as recombinant erythropoietin, iron therapy, vitamin B12 and folate.
We will discuss available blood products and applicable surgical interventions to develop your individualized care plan. Before your surgery or procedure, it is important we understand your wishes for the use of blood and products. We will make sure you have an updated advance directive we can place in your medical record.
In the immediate post-operative period, if major blood loss is anticipated, you may be admitted to the intensive care unit for close monitoring. If resuscitation is needed, we will not change our predetermined plan of action throughout your peri-operative care. It is important that you also discuss your wishes with your family and medical decision-makers in the event you are incapable of making medical decisions.
Moffitt’s Policy on Refusal of Blood and Blood Products
It is important to understand that your medical management will involve interventions and techniques to reduce blood loss as much as possible. There are always concerns about legal issues for the healthcare team and the hospital when confronted with challenges such as major surgery.
For this reason, Moffitt has adopted the following guidelines:
- The patient will sign a Refusal of Blood and/or Blood Components form.
- The practitioner will discuss with the patient the risks and possible consequences of not receiving blood and/or blood components.
- The blood bank must be notified of this refusal.
- In those instances where the patient’s guardian or next of kin is responsible for serving as the patient’s representative, and after having been thoroughly informed that a transfusion is necessary for the preservation of the patient’s health or life and refuses consent for the patient, the hospital chief operating officer or other person acting in that capacity will solicit legal advice.
It is always our plan to discuss with you the specifics of blood transfusion refusal. It is important to understand what can happen to your body in the event there is an emergency and a transfusion is rejected.
- You have the right to refuse or reject the consent for transfusion unless you have a decreased ability to make decisions, or a legal mandate requires we treat you.
- If you have a decreased ability to make your own decisions, relatives or friends must provide documentary evidence that states blood must be withheld in an emergency or life-threatening situation.
- In the absence of an advance directive, if your status for blood transfusion is unknown, if there is no documentation on your person or blood card available, your doctor is expected to care for you which may include the transfusion of blood.
Note: Information obtained from the National Library Medicine PubMed.