BLOOD TRANSFUSION: EXPERTS DISCUSS MEDICAL OPTIONS FOR PEOPLE WHO REFUSE BLOOD

Admin l Wednesday, May 30, 2018

ITALY, Rome – Not less than 25 Italian scientific societies converged on Friday, November 24, 2017 to x-ray options available for people who refuse blood transfusion for health reasons. Among the scientists are medical bioethics and legal professionals who convened at the University of Padua, the second-oldest university in Italy, for the conference entitled “The Refusal of Blood Transfusion by Adult Patients: What Are the Treatment Options?—Blood Save 2017.”

Speakers at the conference challenged the notion that blood transfusions are traditionally considered harmless and the only life-saving medical treatment option for patients undergoing complex medical or surgical procedures.

One of the visiting experts, Dr. Luca P. Weltert, a cardiothoracic surgeon at the European Hospital, Rome, explained: “We saw today that transfusions can be detrimental and in many cases are not needed.” Dr. Weltert and other clinicians on the program reached this conclusion based on their clinical experience as well as evidence from scientific studies that establish a correlation between blood transfusions and increased mortality, morbidity, length of hospital stay, and other serious health risks for transfusion recipients.

“We saw today that transfusions can be detrimental and in many cases are not needed.”—Dr. Luca Weltert, cardiothoracic surgeon, European Hospital, Rome

According to him, such scientific evidence, along with the high cost of blood transfusions, moved the World Health Organization (WHO) in 2010 to identify the need for patient blood management (PBM)—a multidisciplinary and multimodal approach that focuses on health and patient safety, improves clinical outcomes, and significantly reduces the use of blood transfusions. The WHO issued a resolution that urged all 193 member states of the United Nations to implement PBM strategies.

Also speaking, Professor Stefania Vaglio, chief of transfusion medicine at the Sant’Andrea University Hospital, Rome, discussed at length the new culture of PBM, stating that formerly, medical care was dependent on handling and administering donor blood, but now “the focus has been completely switched from donor blood to a patient’s own blood.” One of the objectives of PBM is “to minimize blood loss by putting the patient at the center of the process, . . . focusing attention and doing all that is necessary in order to preserve the patient’s blood.” Professor Vaglio also clarified that medical techniques to conserve a patient’s own blood “actually mean better quality treatment.”

Dr. Tommaso Campagnaro, a general surgeon at the Verona University Hospital, confirmed the benefits of using strategies to avoid blood transfusions. After completing an analysis of data going back as far as the late 1990s involving patients undergoing the most complex abdominal surgical procedure, he concluded: “The patients who did not receive transfusions had less complications and a lower mortality rate compared to transfused patients.”

Dr. Campagnaro, along with several other conference speakers, publicly thanked Jehovah’s Witnesses for helping to prompt doctors to develop alternatives to blood transfusions. Anna Aprile, associate professor of medical law at the University of Padua, stated: “We thank Jehovah’s Witnesses, who have raised the issue of the right to refuse transfusions, helping everyone to reflect on this issue and to meet the challenge of using less blood.”

“Patients who receive blood transfusions are sure to face more complications and problems, as the scientific literature and the statistics indicate. A higher number of blood transfusions correlates with more complications and deaths. So, the association between transfusion and mortality is a reality. In reality, the experience with Witness patients has influenced the treatment methods for all our patients. It has allowed us to make great improvements, and we thank them for that, because as you’ve seen, we’ve been able to reduce significantly the use of blood for all our patients”, he said.

“We thank Jehovah’s Witnesses, who have raised the issue of the right to refuse transfusions . . .”—Anna Aprile, associate professor of medical law, University of Padua

Dr. Weltert adds: “Aortic dissection repair in contemporary surgical therapy represents the biggest surgery that you can do on a human body. . . . If [this] can be carried out without blood, then really anything can be done”, he said.

Professor Pia Di Benedetto, Chief of Anesthesiology, Sant’Andrea University Hospital, Rome said, “My anesthesiology colleague, Professor Paolo Grossi—who is present today—and I have shared the same view of bloodless surgery for the past 25 years. We both have cooperated with orthopedic surgeons, who were probably the first to agree on our approach to bloodless surgery. . . . So, having worked with them for many years, bloodless surgery has become a reality, a reality that we finally see is beginning to be accepted by everyone.”

For Professor of General Surgery, Verona University Hospital, “We have been treating Jehovah’s Witness patients for about 30 years. It has been a very important incentive for us to solve the problems associated with blood transfusions, and not only in relation to Jehovah’s Witnesses.”

Dr. Samuel Mancuso, Conference chairman; cardiac surgeon, University of Turin, Maria Pia Hospital said the number of patients that refuse blood transfusions for clinical and medical reasons is increasing.

“Why? It is not only out of concern for transfusion risks but because of the notion that bloodless medicine is better medicine. If I, as a patient, refuse a blood transfusion, I will receive better care, caregivers will prepare me well in advance, everything will be done in a meticulous way, and I will bleed less. If I lose a lot of blood during surgery, doctors will give my blood back to me, and I am guaranteed that they will follow a very strict protocol. Therefore, it is not only Jehovah’s Witness patients who are requesting this kind of [transfusion-free] procedure.”