It may surprise many
learn that the most complex transportation system in the world is not in Tokyo or New York City, but inside each one of our bodies. Within our veins and arteries flows a most unique substance — blood — ”the river of life that surges within us.” (Marieb & Hoehn, 2016) For many decades, lost blood has been replenished using allogeneic blood transfusion to sustain vital blood values. Unfortunately, blood transfusions carry many risks and are completely out of the question for some patients. As a matter of fact, my interest in the topic of bloodless medicine is based on my religious beliefs as one of Jehovah’s Witnesses; my conscience would not allow me to accept a blood transfusion. Although bloodless care and patient blood management have repeatedly proven themselves to be a superior standard of care, my research journey has taught me that relatively few physicians are adequately educated and equipped to treat a patient without blood. This c an prove to be lifethreatening for many patients, whether their request for bloodless care stems from religious, medical, or personal convictions. I would like to question why blood transfusions remain the standard treatment for serious blood loss despite countless studies justifying the use of blood management techniques. Additionally, I intend to expound on the significance of the sanctity of blood in my personal opinion. I further intend to address my claim of value in light of a physician’s responsibil ity toward life. Lastly, I plan to analyze each step of treatment in various case studies in order to substitute blood managing measures that could have been implemented for the well being of each patient. It is my hope that this deep examination of patien t cases will allow me to find room for improvement in bloodless medicine and give me the opportunity to contribute to the future of blood management. Parts and Functions of Blood Unique in that it is the only fluid tissue in the body, blood is a complex c oncoction of living cells and a nonliving fluid matrix called plasma, which composes about 55% of whole blood. (Marieb & Hoehn, 2016) This fascinating fluid can be separated into four components — red blood cells, white blood cells, platelets, and plasma. Through the lens of a microscope, one would find a peculiarly strong presence of pink, donutshaped cells in a sample of blood. Erythrocytes, popularly known as red blood cells, are the most numerous of blood cells. (Bain, 2017) Though they only live for a pproximately 115 days, the commission of the erythrocytes is far from trivial. (Franco, 2012) Red blood cells are produced in the bone marrow of large bones and their nuclei are ejected prior to their release into the bloodstream. (Bain, 2017) Thereafter, a complex protein called hemoglobin fastens itself to the red blood cells, carrying along with it an element essential to life — oxygen. Accordingly, as red blood cells passively drift through veins, arteries, capillaries, and chambers of the heart, hemoglob in releases oxygen and rejuvenates every tissue it comes in contact with. (Bain, 2017) This lifepreserving function of blood is truly a miracle. Still, the role of blood hardly ceases at transportation. Leukocytes, or white blood cells, stand as a united militia within us providing protection from countless hostile pathogens. These soldiers can be divided into two broad categories: granulocytes and mononuclear cells. (Bain, 2017) Granulocytes are responsible for the general inflammation that is experience d following any wound or infection. Mononuclear cells, on the other hand, are vigorously trained in the thymus and bone marrow to recognize and attack specific pathogens based on the body’s antibody memory. (Bain, 2017) Unlike erythrocytes, white blood cel ls retain their nuclei but lack hemoglobin. (Informed Health Online, 2015)
Though small and anucleate, platelets, or thrombocytes, have an infinitely important duty. After a wound is inflicted and bleeding begins, platelets bind together to seal the damag ed blood vessel wall. (Informed Health Online, 2015) Without functioning platelets, ceaseless bleeding can cause even a minor papercut to become a significant injury. Thus, these shortpieces of larger cells miraculously disarm several fatal f lived broken orces in the world around us. The last and most voluminous constituent of blood is plasma, a nonliving extracellular matrix. Although 90% of plasma is composed of water, the remaining 10% of this matrix — comprised of several vitamins, nutrients and electro lytes — shoulders many burdens. (Informed Health Online, 2015) One specific plasma protein, albumin, maintains a delicate acidbase balance, precise capillary permeability, and steady fluid volume, contributing to stable osmotic pressure. (More & Bulmer, 201 3) After gaining insight on these superlative functions of the liquid which flows within us, one can only be left in awe. Blood Transfusions Remain Standard Treatment Blood has long been believed to be “magical — an elixir that held the mystical force of li fe.” (Marieb & Hoehn, 2016) Therefore, it comes as no surprise that "physicians have been brought up with the idea that blood is the gift of life and that inherently, blood is good for you." (Jehovah’s Witnesses, 2001) Perhaps herein lies the secret to the transfusions. popularity of blood Blood transfusions have long been accepted in the field of medicine. They have been considered a conventional — almost default — treatment for those who have lost a large volume of blood due to trauma or invasive surgery. Fu rthermore, blood transfusions are often seen as traditional treatment for a number of patients suffering from active blood disorders. One such disorder is anemia, a deficiency of oxygenated blood due to blood loss, lack of RBC production, or accelerated RBC destruction. (MedLine Plus, 2017) The various types and bloodless management of anemia will be further discussed. Thalassemia is another namely congenital hematological disease. A patient suffering from thalassemia cannot make enough RBCs or hemoglobin , which may eventually lead to an anemic state. (MedLine Plus, 2017) Hemophilia, a third blood disorder, has endangered many lives. In this case, the body lacks the clotting factor that platelets normally possess, rendering the body incapable of healing it self. When applied to transfusion, the term allogeneic refers to the taking of another’s blood into one’s body, whereas the term autologous indicates the storage of one’s own blood for retransfusion. (USADA, 2014) Autologous transfusion is more commonly u sed preoperatively when a patient is expected to lose a large volume of blood during a surgery. When treating said blood disorders, however, allogeneic blood transfusions are typically used. This truth is attested to by the fact that every year, approximat ely 92 million units of blood are collected from donors worldwide. (World Health Organization, 2011) Nevertheless, there exists a population for whom blood transfusion is altogether not an option. For either personal, medical, or religious reasons, this group of people has chosen to avoid blood transfusions at all costs in both elective and emergency situations. A large fraction of this group consists of Jehovah’s Witnesses, who, on the basis of Biblical principle, believe that accepting blood transfusions would endanger their relationship with God. Others avoiding blood transfusion may include patients who have developed allergic reactions to donor blood due to over transfusion. (Karkowsky, 2013) Still others have researched the risks associated with blood transfusions and have consequently chosen to abstain from them.

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