Q&A Sessions

The Q&A section of this site is currently closed to new questions. If you have any questions about bloodless medicine or the services of the University of Pennsylvania Health System, please call us at 800 789-PENN (7366).

Phil asks:
I have chronic lymphocytic leukemia (CLL) and am currently being seen by a doctor in New York. My red blood cell count has started to decline and my doctor has indicated he is willing to provide non-blood care. I am 54 and otherwise in good health. Should I be considering a stem cell transplant? My doctor says he cannot do a bloodless transplant and is not convinced that it is possible. He is a true extpert in CLL but not in bloodless care. I'm not sure what to do.

Response:
Stem cell transplantation is usually not the first or standard option in CLL. It would be best to stay with your oncologist; however, Pennsylvania Hospital does perform stem cell transplants if this is recommended at any point.

Philly Native asks:
I have a gigantic cyst that extends from my uterus through the rectal area. I was told two surgeries must be done simultaneously to remove it — one by a gynecologic oncologist and one by someone who does colorectal surgery both located in Maryland near DC.

I'm told blood may be an issue. I am a Jehovah's witness. Can you tell me if surgery can be performed in the area? In reading a response to a previous viewer you state that some complicated procedures cannot be done in the facilities you listed.

Do you believe this is a process that should be done through the Penn Health System? Time is of the essence and I would hate to be referred to these facilities only to waste time in getting this resolved.

Response:
Yes, these procedures should definitely be done here. Please call the Center for Bloodless Medicine and Surgery at 888-451-6060. They will assist you with scheduling appointments with the appropriate physicians.

Donna asks:
My father has 6 stomach ulers and suffered from internal bleeding. He is on Plavix b/c he has 7 stents around his heart. (He is 80 yrs old) He was told he needs to have the ulcers cauterized but they will not perform the surgery without a blood transfusion. Can Franklin Square's doctors perform ulcer cauterization without the use of blood or blood products?

Response:
It would be best to contact Franklin Square directly to find out if they perform bloodless procedures.

Bernie asks:
What are Procitin shots?

Response:
Procrit injections are a man-made form of erythropoietin, which stimulates the production of red blood cells. Sometimes, your body does not make enough erythropoietin, and that may cause anemia.

Epoetin alfa (Epogen®, Procrit®) treats anemia associated with chronic kidney failure, cancer chemotherapy, or HIV-therapy. Epoetin alfa may also be used before surgery if you have anemia.

Evelyn asks:
My dad needs a liver transplant, due to end stage cirrhosis (because of hemochromatosis). Do you participate in bloodless (no blood transfusion) liver transplants?

Response:
Thank you for your question; however, we do not perform bloodless liver transplants.

Meg asks:
Are iron supplements the only option for someone diagnosed with anemia? In other words, should I pursue why I am anemic or simply take the prescribed Feratin?

Response:
A hematologist should always be consulted to determine the cause of the anemia.

Crystalsky asks:
I would like to know if it is normal for midwives to test you more then once to count your white blood cells during pregnancy.

Response:
Normally there is an initial complete blood count (CBC) done and another near the end of term. However, if there is an abnormality that needs to be checked, your health care provider may want to do a white blood cell test during pregnancy.

Pete asks:
What is Mylodisplastic syndrome?

Response:
The myelodysplastic syndromes (MDS) are a group of diseases in which the production of blood cells by the bone marrow is disrupted. In contrast to leukemia, in which one specific type of blood cell (the white cell) is produced in excessively large numbers, the production of any, and sometimes of all, types of blood cells is affected.

Question:
What can be given to a Jehovah's Witness in need of blood?

Response:
It depends on the need. Anemia would be treated differently from an acute blood loss.

Jay asks:
I'm a Jehovah's Witness and I'm looking for a bloodless hospital. My cardiologist says that I need a ICD/Defibrillator and the electrophysiologist is to perform the surgery soon. My hospital is not bloodless and neither doctor is a bloodless doctor. I do not feel comfortable having them perform the surgery if blood becomes an issue during the surgery.

Could you recommend or provide a list of bloodless hospitals and/or electrophysiologists who can do this procedure without blood? Also, the HLC name and number for each hospital.

Response:
Please contact:

Randy Henderson
USC University Hospital / USA Norris Cancer Hospital
Transfusion-Free Medicine and Surgery Program
1500 San Pablo St.
Los Angeles, CA 90033 USA
(323) 442-5263

Barbara asks:
I am scheduled for laporoscopic removal of both non-cancerous ovaries (have a dermoid cyst on one). Is removal of the uterus suggested also?

Response:
Removal of the uterus would be suggested, only if your gynecologist recommends it for disease reasons, i.e. fibroids.

Ironpeg asks:
My grandson goes in for heart surgery soon. He has Down Syndrome Mosaic and a ventricular septal defect that needs to be repaired. We've had doctors tell us that they would try to do it bloodless but they want us to sign a consent form that states in the event that something goes wrong they want to be able to give him blood. Due to our religious beliefs, we cannot ethically do that so now they are going to take over medical custody of my grandson from my daughter. Is there a hospital that we can work with in or near the area?

Response:
If you a Jehovah's Witness, we would recommend that you get the local Hospital Liaison Committee (HLC) involved.

Lizzy asks:
My mother has been diagnosed with MDL catagory 2. She is bruising quite a lot. Iis there anything we can do to increase her platlette count? Even naturally? We live in australia so realize the availability of things is different here.

Response:
In order for us to better answer your question, please clearly specify your mother's diagnosis.

Brandon asks:
My wife has placenta privea and I was wondering if the surgery can be handled without blood.

Response:
In this situation, there can be sudden and rapid loss of blood which could cause death, if the patient is not given blood products.

Jean asks:
My platelet count is up to 453,000 & MD states it is too high. I recently had a Thyroidectomy 3.5 weeks ago , could this have something to do with this. My calcium level has been running between 8.5-9.5, & currently on 1000 mg daily of calcium with Vitamin D & 150mcg of Levothyroxine, all other test are within normal ranges.

Response:
An elevated platelet count can be benign and secondary to any inflammation such as a recent surgical procedure. This usually resolves itself in a few weeks and therefore no intervention is needed. If this predated a surgery and/or persists, a hematology consult may be necessary.

Nah asks:
Do you know any hospital or facility in Pennsylvania that does red cell mass test and plasma volume test?

Response:
Hospital of the University of Pennsylvania 3400 Spruce Street Philadelphia, PA Specifically, you should contact Penn Radiology. For more information, please call 1-800-789-PENN (7366). You can also request an appointment online.

Pooh Bear asks:
I am confused about EPO. I've been doing research and found that Procrit® is a synthetic version. Is it completely synthetic? One website I found said to tell your doctor if you are allergic to medications made from albumin before taking Procrit®. Albumin is a blood fraction, therefore not synthetic. My conscience does not allow anything made from blood fractions. I need to have surgery and my doctor wants me to take Erythropoietin before surgery. Is there one NOT made from blood fractions? Thanks!

Response:
A small amount of albumin is added to EPO as a stabilizer in the US product, this is to prevent the molecules of the EPO from sticking to the vial. Religions such as Jehovah's Witnesses which forbid the transfusion of whole blood, packed RBCs, and plasma, as well as WBC and platelet administration do not prohibit the use of components such as albumin, immune globulins, and hemophiliac preparations. Each Witness must decide individually if he can accept these. -Awake 06/22/82 p. 25

Steve asks:
I am in need of a complete knee replacement but am a Jehovah's Witness, since I live in Oklahoma do you have a program for patients who have to travel or know of a hospital in the Oklahoma City area that has a bloodless program?

Response:
If you would like more detailed information on our program, please call 1-800-789-PENN (7366). The closest program to you is at Christus Health St. John Hospital in Houston, Texas. You can contact Jessica Varisco at (281) 333-8878.

Donna asks:
I am a 50 year-old woman who may need a hysterectomy due to the fact that I experience heavy bleeding during my period. I have fibroids and my uterus is the size of a four month pregnancy. Due to my religious beliefs, I am looking for a doctor and medical facility who would be willing to perform the surgery without blood or blood products. Can you help?

Response:
Yes, we can help. Please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital. You can also request an appointment online.

Jena asks:
Can a large (equal of five months of pregnancy) uterine fibroid be removed without a cut, through the vagina?

Response:
From your description, that fibroid is probably too large to be removed without an incision. However, other treatments might be available depending on a person's history and symptoms. To schedule an appointment, please call 1-800-789-PENN (7366). You can also request an appointment online.

RM asks:
I need a list of medicines to use to raise my blood level (Hb).

Response:
Erythropoietin along with intravenous iron is the best treatment. You can also increase the protein (red meats) in your diet, and green leafy vegetables which are a good source of iron.

Karen asks:
My husband is 29 years old and has A.L.L. (T cell). Have you successfully treated his condition without the use of blood or any blood components and achieved long term remission?

Response:
An allogenic stem cell transplant is usually the preferred treatment for acute lymphocytic leukemia (ALL). This type of transplant uses the healthy bone marrow of a relative or donor to repopulate the patient's cells after the cancer is eliminated through chemotherapy. However, we do not perform this type of transplant.

We have done autologous transplants here at Pennsylvania Hospital. An autologous stem cell transplant involves removing stem cells from the patient's own marrow, storing them and then returning them to the body after the patient receives high doses of chemotherapy and/or radiotherapy conditioning therapy. There are some transplant centers that have done selected allogenic transplants.

Merle asks:
In chronic renal failure (CRF), why is the hemoglobin level kept between 11-12?

Response:
The hemoglobin is kept at that level because higher hemoglobin levels are associated with better outcomes (improved quality of life and less chance of cardiac-related events).

Dawn asks:
My grandmother has to have a trech in her neck to help assist in breathing. However her hemogloblin is staying at 6.5 and the doctors are questioning whether the surgery could be done without her having a blood transfusion. Do you know a hospital that will do it?

Response:
We can perform this surgery. Please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital.

Phil asks:
What decreases in mortality rates have you observed with bloodless medicine, particularly post-operative?

Response:
Since our program utilizes bloodless techniques, our patients have a lower risk of developing an infection and fewer complications due to fever, bacterial contamination/shock, and hives. There is a lower chance of human error and the length of stay in the hospital is typically shorter. The amount of blood lost is lower, which reduces risk and improves post op recovery.

Judy asks:
What does a low white platelet level cause?

Response:
White platelets do not exist. There are white blood cells and platelets.

White blood cells protect the body from infection. People with low white blood cells tend to develop infections easily because their white blood cell count is too low to fight off germs, such as bacteria. Most of these infections occur in the lungs, mouth, throat, sinuses, and skin. Some people get gum infections, ear infections, or infections of the urinary tract, colon, rectum, or reproductive tract.

Platelets are the tiny cells that seal minor cuts and wounds and form blood clots. A person with too few platelets bruises easily and bleeds for a long time after being injured. When the platelet count is very low, nosebleeds that are difficult to stop, or internal bleeding may occur.

Jo asks:
My best friend is in need of a liver transplant. We live in Montana. Is there any place close to us, either in the US or Canada, that will perform this surgery without blood?

Response:
You can contact:

Ms. Tabatha Storer (Coordinator)
St. Vincent Healthcare
PO Box 35200
Billings, MT 59107 USA
(800) 762-8778

Olvonne asks:
I'm a school teacher and stopped work in Nov. 2005. I've had a hysterectomy, and was on the Climara Patch for ten years. In December 2005, after experiencing stomach pain, I was told I needed surgery for build-up of scar tissue opposite my hysterectomy scar.

By this time, I had lost 25 pounds, was nauseous, had body aches, loss of appetite, hot flashes, headaches. An Ear, Nose and Throat doctor determined I had polyps in my sinuses and removed what he called a large fungus ball in March. I've been on antibiotics since December. I've continued to lose weight, and continue to have the same symptoms. Now, I have a hernia in my groin area. The doctor recommends surgery for the hernia and gave me a diagnosis of anemia, but I'm allergic to iron shots and pills. He also says I still have infection in my body.

Is there any way I can build up iron, in addition to eating leafy greens and red meat? Are there other treatment for menopause and other ways to clear up infections quicker? Can you also recommend a medical specialty that might be able to get to the bottom of my problems and get me back to the classroom?

Response:
If your allergic reaction was due to iron dextran sensitivity, FERRLECIT has been shown to be well tolerated in patients with prior iron dextran sensitivity. Additionally, erythropoietin will assist in building up the red blood cells.

You should consult with your Gynecologist in regard to your menopause concerns and your family doctor regarding the infection issue.

A hematologist would be able to address your anemia concerns.

Katy asks:
We are looking for a pediatic cardiologist that will do bloodless surgery for our 14 year-old son. We were told by his cardiologist that he will need a balloon stent in the aorta. At three weeks he had coarctation of the aorta. We are also looking for a very skilled pediatric cardiologist that understands the aortic valve repair technics for a bicuspid valve. Do you have any suggestions?

Response:

Jessica L. Varisco
Christus St. John Hospital
Transfusion Free Med/Surg. Program
18300 St. John Drive
Nassua Bay, TX 77058
(888) 411-7527

Geneva asks:
My red blood cell (RBC) and white blood cell (WBC) counts have been low for a period of about one year. My RBC has been in the area of 3.5 to 3.7 during this period. I am taking a Vitamin B-12 shot weekly and iron tablets. Is there any way that I can build up my RBC fast? My last test results: RBC 3.66, WBC 4.0, HG 10.2 and HC 31.0.

Response:
Intravenous iron and erythropoietin are the best treatments. You can increase the protein (red meats) in your diet, and green leafy vegetables which are a good source of iron.

Woody asks:
I read about the Gamma Knife radiosurgery in your spring newsletter. Can it be used for the third most common movement disorder, dystonia? If not, are there any possible plans in the future?

Response:
Gamma Knife radiosurgery can be used for dystonia, but in general a surgical procedure would a better option.

Sandy asks:
I am a Jehovah's Witness and I am pregnant. There is a lot of talk about blood cord and stem cell banking. I can't seem to find any info on whether the cells are extracted and then frozen or is the blood frozen and then when you need the cells they are extracted. I would think that I would be okay if they were extracted right away and then frozen, but definitely not with the storage of the blood. Any info would help.

Response:
After birth and after the umbilical cord is cut, the blood is drained out of the placenta and remaining umbilical cord, thus the term, "cord blood." This blood is rich in baby's "stem cells," which are immature blood cells that are able to change and mature into any type of blood cell as baby grows, just like bone marrow cells.

These cells are preserved in a storage facility, ready for use when needed. The OB or Midwife collects the blood from the remaining umbilical cord and placenta into a syringe or blood bag. The cord blood is shipped to the cord blood bank. Once there, it is processed. The stem cells are removed from the cord blood, and it is placed into deep freeze storage.

Joyce asks:
I am in need of a hysterectomy because of excessive bleeding, enlarged cervix, small fibroid and endometriois to be performed without the use of blood. Do you do this and if so by what methods?

Response:
We perform Laparoscopically Assisted Vaginal Hysterectomy (LAVH) which is a surgical procedure that uses a laparoscope, or viewing tube, to remove the uterus and/or Fallopian tubes and ovaries through the vagina and is done without blood transfusions.

During the procedure, several small incisions are made in the abdominal wall and thin, metal tubes known as trocars are inserted to provide a pathway for the laparoscope. A camera attached to the laparoscope allows a magnified image to be projected onto a television screen. Using the laparoscopic tools, the uterus is detached from the ligaments that attach it to the other structures in the pelvis, and is then removed through an incision in the vagina.

Compared to an abdominal hysterectomy, which requires a vaginal incision as well as a four to six inch long incision in the abdomen, an LAVH requires small incisions, reducing the amount of blood loss, scarring, pain and recovery time for the patient. The LAVH also allows the Fallopian tubes and ovaries to be easily removed; whereas, in a vaginal hysterectomy - the removal of the uterus through the vagina - the tubes and ovaries may be more difficult to remove. For certain women, the LAVH is the best option since it allows the upper abdomen to be thoroughly evaluated during the surgery.

Our Fall 2005 Newsletter recounts a success story. If you would like to schedule an appointment, you can call 1-800-789-PENN (7366) or you can also request an appointment online.

Rouge asks:
My father has had PSC of the liver and is considering a bloodless liver transplant. He is a witness and has contacted the hospital liason comittee. Are there any Canadian bloodless hospitals that could do a liver transplant? We are also awaiting the Liason Committee's response.

Response:
You may contact the following hospitals:

Ms. Susan Gagne RN
Perioperative Blood Conservation
Niagara Health System
142 Queenston Street
St. Catharines, Ontario L2R 7C6 Canada
905-378-4647 x6570

-or-

Ms. Rosemary Koen
St. Michael's Hospital
30 Bond Street
Toronto, Ontario M5B 1VB Canada
(416) 864-6060 x4055

Brett asks:
What are my options/hopes for a bloodless repair of a coarctation of the aorta on my 3-day old infant?

Response:
Contact the following hospitals in your area who may be able to provide you with more information:

Ms. Loretta Humes RN
Roper Hospital
Bloodless Medicine and Surgery Program
316 Calhoun Street
Charleston, SC 29410 USA
(843) 724-2399

-or-

Ms. Eunice Johnson
McLeod Regional Medical Center
555 East Cheves Street
Florence, SC 29505 USA
(843) 777-2000

-or-

Ms. Yvette Bunch
Spartanburg Regional Healthcare System
100 East Wood St
Spartanburg, SC 29303 USA
(864) 560-6148

Robert asks:
I have mantle cell NHL and have begun chemo treaments (RCHOP). I was told I would need a bone marrow replacement. I would like to know more about this procedure performed without blood.

Response:
Bone marrow transplants have been replaced with a much more effective procedure called stem cell transplant. This procedure involves collecting circulating stems cells through a machine very much like a dialysis machine.

The first part of the process is getting the stem cells to move out of the bone marrow (where they live) and into the bloodstream. This is done with the medication neupogen. The patient has to inject the drug twice daily for five days prior to collection and then during the collection. This causes an increase in production of white blood cells too. It has a side effect of some bone pain, mostly in the back or upper legs.

The day before we collect, a special catheter is inserted into a vessel to collect the cells. The next two days the machine runs the cells, collects the ones needed and gives back the rest of the blood. It is a continuous process. Once we collect enough cells, no more injections are required and the collection stops. The catheter is then removed. The cells are then frozen and kept at the Red Cross until they are needed.

Steph asks:
What is low hemoglobin a2?

Response:
Hemoglobin is the iron-containing oxygen-transport protein in the red cells of the blood in mammals and other animals. Hemoglobin transports oxygen from the lungs to the rest of the body, such as to the muscles, where it releases the oxygen load. When you don't have adequate red blood cells in your blood, you have anemia or low hemoglobin.

Normally about 1 percent of the red blood cells retire every day, to be replaced by about the same number of fresh, young red blood cells.

Anemia occurs when the production of red blood cells is insufficient, when too many red blood cells are destroyed, or when blood is lost (through bleeding).

Eva asks:
What hospital in Texas offers bloodless medicine?

Response:

Jessica L. Varisco
Christus St. John Hospital
Coordinator, Blood Conservation/Management Program, Advance Directives Educator
Transfusion Free Med/Surg. Program
18300 St. John Drive
Nassua Bay, TX 77058
(281) 333-8878

Angela asks:
I was wondering if ya'll did bloodless live donor liver transplantion. If so, I would like to get some information on it. How long have ya'll been doing it and what is the success rate?

Response:
We do not perform bloodless liver transplantation. However, below is contact information for a hospital in Texas who performs bloodless liver transplantation:

Jessica L. Varisco
Christus St. John Hospital
Coordinator, Blood Conservation/Management Program, Advance Directives Educator
Transfusion Free Med/Surg. Program
18300 St. John Drive
Nassua Bay, TX 77058
(281) 333-8878

Clarice asks:
Do you perform lung transplants without blood?

Response:
We do not perform lung transplants without blood. However, there are options available for lung transplants without the use of blood. Following is contact information for these programs:

Jessica Varisco at the Conservation Program in Houston, Texas has a number of physicians willing to perform bloodless procedures for lung transplants.

You could also contact Heidi Waitkus at the University of Massachusetts Medical Center. Her phone number is (508) 856-2715.

Dgayrn asks:
What is the life expectency of a person diagnosed with AML? The person is a Jehovah's Witness who refuses any treatment with a current hemoglobin level of 3.8 and receiving Procrit three times per week.

Response:
There are many different factors of an individual AML diagnosis that provide prognostic information (type, chromosome analysis etc). Any hematologist will be able to specifically determine this. On average survival is 30%. However this prognosis is based on the ability to receive full therapy which almost universally requires multiple blood transfusions.

Not much data exists in treating Jehovah's Witnesses.

Attempts have been made at our Center and others to give reduced doses or drugs such as Mylotarg, which are not usually used as first line therapy, in the hopes of helping some. We would be happy to discuss the patients' options further. Please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital.

DMF asks:
This question is for Dr. Ford. My mom is one of your patients; she has CML and is undergoing a procedure where you are freezing her stem cells? Can you please explain this procedure to me or send me some information on it. I would truly appreciate any information you have.

Response:
The procedure involves collecting circulating stems cells through a machine very much like a dialysis machine.

The first part of the process is getting the stem cells to move out of the bone marrow where they live and into the bloodstream. We do this with the medication neupogen. The patient has to inject the drug twice daily for 5 days prior to collection and then during the collection. This causes an increase in production of white blood cells too. It has a side effect of causing some bone pain, mostly in the back or upper legs.

The day before the collection, a special catheter is inserted into a vessel used to collect the cells. The next two days the machine runs the cells, collects the ones needed and gives back the rest of the blood. It is a continuous process.

Once we collect enough cells, the collection and injections stop and the catheter is removed. The cells are then frozen and kept at the Red Cross until they are needed.

Lindsey asks:
How does bloodless surgery work? What do you do to make it bloodless?

Response:
"Bloodless" is medical or surgical treatment without the use of banked or stored allergenic blood or primary blood components (whole blood, red blood cells, white blood cells, platelets and blood plasma). Blood loss often occurs during surgery. The goal of bloodless care is to minimize blood loss through the use of special blood-conservation methods.

DuaneQ asks:
Can you help a Jehovah's Witness that is in the need of a lung transplant?

Response:
A Jehovah's Witness in need of a lung transplant should contact a local member of the Hospital Liaison Committee (HLC). HLCs have the resources available to respond to the needs of the Jehovah's Witness patient.

Lisa asks:
How often can one receive procrit shots?

Response:
The recommended dose is 20,000 units three times per week.

Ashley asks:
My dad was diagnosed an EF of 15% (cardiomyapathy) CAD, and a positive reversible ischemia LAD and circumfence and also mitral valve regurt +4. He needs to have mitral valve repair/replacement, and five bypasses. How is this done with bloodless surgery?

Response:
This would be a challenging case to do even without the requirement for eliminating blood transfusion and even more so using a bloodless technique. Is this patient a Jehovah's witness (e.g., has a religious commitment to avoiding blood transfusion)? The patient would need to be counseled that there is very little data to base our decisions on in this type of situation.

In terms of "how is this done?", we would use all of the methods we always use in bloodless cases: salvaging all blood lost during surgery and returning it to the patient, removing two to three units of the patient's blood in the operating room prior to the start of the procedure, minimizing the loss of blood through limiting the number of sponges used ("one sponge technique") and meticulous surgical technique, and most recently, using a miniature heart lung bypass circuit and "priming the circuit" with the patient's own blood rather than salt water to minimize the dilution of blood.

Jessica asks:
Can you die from being anemic?

Response:
Yes, approximately 4600 people die from anemia each year in the United States.

Question:
What do you think bloodless surgery will be like in the next two years?

Response:
We see bloodless medicine and surgery coming into the mainstream. Blood will continue to increase in cost and dangers of blood will continue to rise. This will necessitate further exploration into non-blood medical alternatives.

Marisol asks:
My son is diagnosted with Atypical HUS. Do you have any suggestions for bloodless treatments?

Response:
Atypical HUS will sometimes follow the use of certain drugs, or follow pregnancy or cancer. Rather than being caused by an external agent--such as a food borne pathogen, cases of Atypical HUS seem to be caused by some internal factor.

Our bloodless center does not care for the pediatric patient population. It would be to your advantage to contact a children's Bloodless Center close to your home.

Cecilia J. Wells
Clinical Coordinator, Blood Avoidance Service
DeVos Children's Hospital
100 Michigan NE
MC 117
Grand Rapids MI 49507

Tiffysimone asks:
How dangerous is correcting an ASD (atrial septal defect) in an adult (age 23) with relatively good health, without the use of blood? What is the general length of stay in the hospital?

Charles Bridges, MD, ScD responds:
This procedure is very safe. I personally have done several of these procedures without any complications. The operation is short; it takes about two hours or less. The mortality should be less than 1% (>99% survival) even without blood.

BWH asks:
What is involved in the process known as blood tagging?

Response:
Red blood cell tagging is a test in which the individual's own red blood cells are harvested, tagged with radioactive material, and then returned to the individual. Imaging scans are then performed that will highlight areas of bleeding, because the tagged red blood cells will be seen leaking from these areas.

A similar test for white blood cells is a test in which an individual's own white blood cells are harvested, tagged with radioactive material, and then returned to the individual. Imaging scans are then performed that will highlight areas of infection, because the tagged white blood cells will migrate to these areas.

Jehovah's Witnesses, who do not allow their own shed blood to be stored, consider accepting these procedures as an individual "matter of conscience."

Michelle asks:
Like many others who have questions, I am a Jehovah's Witness. My son who is due in March has tricuspid atresia, and will require three heart surgeries. Do you know of any hospitals that can perform these surgeries, particularly the B-T shunt, without blood?

Response:
As a Jehovah's Witness, you need to contact your local elders who will contact the area Hospital Liaison Committee (HLC) for assistance.

We do not care for pediatric cases at our institution.

Sharon asks:
My mother's bone marrow is not producing enough red blood cells. She gets a shot four times a week and blood transfusion once a month. Is there somthing else we can do?

Response:
The name for this condition is Mylodisplastic Syndrome (MDS). A course of treatment for MDS requires that a number of factors are taken into consideration: the severity of the disease; whether the patient has already been treated already, and how successfully; and the patient's age and overall health. For most MDS patients, no currently available treatment is considered a cure. Current treatment strategies are designed to slow the progression of disease and to alleviate symptoms.

Younger MDS patients -- those 50 years and younger -- may be eligible for a bone marrow transplant, which has been found to be curative in about 25 percent of cases. For patients who are not eligible for bone marrow transplant, treatment options include supportive care, an approach that includes blood and platelet transfusions, antibiotics to treat infection, and erythropoietin, a hormone that stimulates the body to produce red blood cells and G-CSF (granulocyte colony stimulating factor), a growth factor that stimulates production of white blood cells.

For patients whose disease closely resembles leukemia, physicians may use antileukemia therapy. For more information or to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Alivia asks:
What is the normal blood platelet level for children?

Response:
There are normally between 150,000 - 450,000 platelets in each micro-liter of blood.

Smirdrv asks:
I am a student doing some fact-finding for an ethics case. I have a patient with a sub-dural hematoma, elevated blood-alcohol level, and very decreased platelet level. He is a Jehovah's Witness and therefore opposed to transfusions of any blood products. The neurosurgeon refuses to operate without platelet and blood transfusions. Is bloodless medicine or surgery a viable option?

Response:
It would be best to seek out a second opinion and find a willing surgeon.

Jane asks:
What is the surgical management for chronic leukemia?

Response:
There are no surgical options for chronic leukemia. However, a stem cell transplant may be an option. Visit our web site to learn about the Bloodless Stem Cell Transplant Program at Pennsylvania Hospital.

Bonbon asks:
My daughter has cystic fibrosis and needs a lung transplant without blood. She lives in Seattle, WA. Where is the nearest place for this?

Response:

Swedish Medical Center
Mary Ghiglione, RNC
Manager, Blood Management/Bloodless Program
500 17th Avenue
Seattle WA 98122
Phone: (206) 320-2358
Email: Mary.Ghiglione@swedish.org

Khonum asks:
Can you refer me to a bloodless medicine system in the Washington DC area? That includes Maryland and Virginia suburbs. Thank you!

Response:
There are no hospitals offering Bloodless Medicine and Surgery in Virginia. There are three in the Baltimore, Maryland area. However, these may not be fully equipped and staffed to handle complex bloodless care. For more information or to schedule an appointment at Penn, please call 1-800-789-PENN (7366) or request an appointment online.

Here's a list of the Baltimore facilities:

Franklin Square Hospital Center
Cathy Santoni, RN
Program Coordinator, Bloodless Medicine/Surgery Program
9000 Franklin Square Drive
Baltimore MD 21237
Phone: (443) 777-8280
Email: cathy.santoni@medstar.net

John Hopkins University Hospital
Louanne Morell, BSN, RN
Clinical Program Coordinator, Advanced Transfusion Practices
600 N. Wolfe Street
Baltimore MD 21287
Phone: (410) 502-7359

Saint Agnes HealthCare
Patricia Parce, RN
Clinical Coordinator, Mid-Atlantic Blood Management Center
900 Caton Avenue, Mailstop 052
Baltimore MD 21229
Toll-free: 888/626-2724
Fax: 410/951-4007
Email: pparce@stagnes.org

Ernie asks:
Two years ago my wife was diagnosed as having mylodisplastic syndrome. We were told that there was no treatment needed because there was no cancer! My wife developed deadly luekemia in May of 2005. Why couldn't she have been given a bone marrow transplant before the leukemia developed?

Response:
Bone marrow transplant is not routinely recommended for MDS. It depends on the type of MDS, age and condition of patient, and availability of bone marrow donor, as it can be associated with up to 30 percent mortality from procedure alone. There is no way of predicting the course of MDS. Many individuals can live without treatment for years, while unfortunately some progress to acute leukemia.

Franca asks:
I need a hip replacement. I am 62 and in good health. I've never smoked and have been active. How successful are hip replacements without blood transfusions and how many are done without blood?

Response:
Hip replacement without the use of blood is very common. It is a procedure performed regularly at our hospital.

For more information or to schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Brenda asks:
What kind of bloodless treatment is very good for someone that has AML leukimea?

Response:
A stem cell transplant is used to treat patients with Acute Myelogenous Leukemia (AML). Visit our web site to learn about the Bloodless Stem Cell Transplant Program at Pennsylvania Hospital.

Lorin asks:
What are the chances of survival when one is diagnosed with AML and refuse any type of blood? My brother-in-law is a Jehovah's Witness and he needs treatment. You would be surprised at the number of doctors who have refused to treat him because of his conviction for not accepting blood.

Response:
Many different factors of an individual's AML diagnosis provides prognostic information (type, chromosome analysis etc). Any hematologist will be able to specifically determine this. On average, survival is 30 percent. However, this prognosis is based on the ability to receive full therapy which almost universally requires multiple transfusions. Not much data exists in treating Jehovah's Witnesses but one must assume prognosis is very poor and some doctors may truly feel futile.

Attempts have been made at our Center and others to give reduced doses or drugs such as Mylotarg which is not usually used as first line therapy in hopes of helping some.

Lee asks:
Is a bloodless laparoscopic radical hysterectomy for cervical cancer a very high-risk operation? Or do they pair well because of the low blood loss statistics of laparoscopic surgery?

Response:
The level of risk depends on the patient's health, her hemoglobin, the size of the cervical tumor and the experience of the surgeon.

Rud asks:
I need medicine that can be used if you have problem with low blood level.

Response:
Erythropoietin is the name of a chemical normally produced by your body, primarily by your kidneys. Erythropoietin stimulates the bone marrow to produce red blood cells. Laboratory-made synthetic erythropoietin (e.g., Procrit, Epoetin alfa, or Epogen) may be administered prior to a bloodless surgery procedure in order to maximize your bone marrow's production of red blood cells. It is generally given as an injection under the skin and usually needs to be given one to three times a week.

Amy asks:
I am a Jehovah's Witnesses and am going to have jaw surgery on the 29th. My blood count is 8.5 and has been for a long time. I've been taking iron but it's not helping. I want to take the shot but don't know the name of it. Can you help?

Response:
Erythropoietin is the name of a chemical normally produced by your body, primarily by your kidneys. Erythropoietin stimulates the bone marrow to produce red blood cells. Laboratory-made synthetic erythropoietin (e.g., Procrit, Epoetin alfa, or Epogen) may be administered prior to a bloodless surgery procedure in order to maximize your bone marrow's production of red blood cells. It is generally given as an injection under the skin (subcutaneously or SC). It usually needs to be given one to three times a week.

For more information, please see our online glossary.

MsKermy asks:
Do you perform bloodless heart transplant surgeries?

Response:
Bloodless heart transplants can be done at the Texas Heart Institute. Please contact:

Jessica L. Varisco
Transfusion Free Med/Surg. Program
18300 St. John Drive
Nassua Bay, TX 77058

Gayle asks:
My mother is a Jehovah's Witnesses. She has been diagnosed with a very large acoustic neuroma. Do you perform endoscopic surgery there? We've read of good success with this type surgery, but also need to know a place to perform it without blood. Thank you in advance for any help you can give.

Response:
We do perform surgery for acoustic neuroma. Please call 1-800-789-PENN (7366) and ask to be transferred to the office of Peter LeRoux, MD, FACS.

Arlene asks:
I am entering the nursing field and I want to know what field of nursing I should be considering to be able to assist in bloodless surgery. Also, what advice would you give on acquiring experience on bloodless surgery during and after college?

Response:
Someone considering a career in non-blood management should be well versed in the beliefs of those patients who refuse blood for religious reasons, i.e. Jehovah's Witnesses. A BSN is usually preferred with strong managerial experience. This is typically the standard criteria for a Bloodless Medicine and Surgery Program coordinator position.

Rachel asks:
My father just turned 70 and needs a lung transplant. He is in the advanced stages of IPF but is otherwise in good health. He will not take blood. Can you recommend hospitals/surgeons that may be willing to perform a bloodless lung transplant on my father?

Response:
Rachel, you should contact:

Randy Henderson
USC University Hospital
1500 San Pablo Street
Los Angeles, CA 90033
(323) 442-5261

Nana asks:
Do you have any surgeons who specialize in or will perform bloodless surgery on infants with congenital heart defects?

Response:
We do not have surgeons who specialize in bloodless surgery for infants. You should contact the Children's Hospital of Philadelphia.

Evelyn asks:
I am a Jehovah's Witness. I have cancer and a low blood count. Currently I recieve weekly shots of Procrit and I take iron pills daily. What else can I take to increase my hemoglobin?

Response:
You are doing everything you can. If your iron level is very low or you are bleeding, sometimes intravenous iron will bring it up. However, if your iron is okay and you are tolerating the pills, the low hemoglobin may be a result of the cancer or the treatment.

Iron pills and Procrit are the best treatment. You can increase the protein (red meats) in your diet and green leafy vegetables, which are a good source of iron.

Melissa asks:
My mom is 48 years old and has been diagnosed with ALL leukemia in May of this year. She was in remission for about two months and the ALL came back. The doctor is trying a chemo that is usually given with blood transfussions, but she does not recieve blood.

So I wanted to know more about the bloodless stem cell replacement / bone marrow transplant. How much does it cost? Do most insurances cover it? When do you usually recommend it to be performed? What are the sucess rates? What are the risks? How is this surgery performed? I would really appreciate an answer back from you and thank you very much.

Response:
Bone marrow transplants are performed in two ways. One way, usually for non-leukemia, takes the stem cells out of the blood through a machine (like a dialysis machine) and freezes them. The patient is then given the treatment of high dose chemotherapy, and the stem cells are given back two to three days after the chemotherapy is complete. The stem cells (immature blood cells) go back into the bone marrow and new cells begin to grow, helping the patient recover from the treatment. The hope is that the cancer cells are destroyed by this high dose of chemotherapy. This is an autologous transplant.

The other type of transplant is an allogenic transplant. This is usually the preferred treatment for ALL. A relative or donor's bone marrow is used to re-populate the patient's cells, which have been cleaned out by the chemotherapy. The goal of this treatment is to destroy the cancer cells and replace them with healthy cells. We have done autologous transplants here and there are some transplant centers that have done selected allogenic transplants.

Bone marrow, or stem cell transplants, are usually covered by insurance once they have been pre- approved. An allogenic transplant is more expensive because the recovery period is much longer.

Timing is dependent upon the disease and the protocol. You should have a discussion about this with the physician treating your mom. He/she would be your best resource because he/she knows her case.

Mike asks:
What is the availability of PolyHeme?

Response:
Clinical trials for PolyHeme are currently being conducted at approximately 20 trauma centers nationwide.

Saul asks:
I am a Jehovah’s Witness. I need a kidney transplant without the use of blood. I have diabetes with cardiovascular complications. I live in Maryland, near Washington, DC. I am looking for information of bloodless surgeons and hospitals that may help me in my health condition.

Response:
The closest hospital for non-blood kidney transplant surgery is:

Bloodless Medicine and Surgery Program
Memorial Medical Center - Mercy Campus
301 North Jefferson Davis Parkway
New Orleans, LA 70119

504-483-5109 (voice)
504 485-5631 (fax)
888 878 3936 (toll free pager)
877 426 7766 (toll free voice)

Specialties: All general surgeries, orthopedic, gynecology and kidney transplant

Contact: Deborah L. Arceneaux

Cheryl asks:
My husband is a Jehovah's Witness and he has B cell CLL leukemia. His spleen was at 24cm and is shrinking some but he does not want any more chemo. Can you operate and take the spleen out even though it's a little big without blood?

Response:
Yes, we can operate. For more information or to schedule an appointment, please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery.

Bonnie asks:
Can bloodless surgery be done on a patient who has an enlarged spleen?

Response:
Yes, bloodless surgery can be performed on a patient with an enlarged spleen.

Bobbie asks:
I am a Jehovah's Witness and would like to find out what is involved with the Zimmer Hemovac Auto Transfusion System? I am having a unicompartmental knee replacement done and this is one of the options giving me to consider for non blood use.

Response:
The Zimmer Hemovac Auto Transfusion System is very similar to a cell saver machine which salvages blood cells during surgery. This is commonly acceptable by Jehovah's Witnesses. The difference is that the Zimmer Hemovac Auto Transfusion System is used up to 24 hours after surgery. For the Jehovah's Witness patient, it is acceptable and can be set up in a closed circuit.

Question:
My sister went into a diabetic coma two weeks ago and has a very low blood count. We are looking for alternative ways to help her recover without the use of blood. Do you have any hospitals in the Pensacola area?

Response:
The University of Pennsylvania Health System does not have any hospitals in that area, but below are hospitals that we know of:

Phoebe Putney Memorial Hospital
(240 miles from Pensacola, Florida)
417 Third Avenue
Albany, GA 31701
(229) 312-1000
Contact: Pamela Ruyle
Toll Free# (887)-653-0001

-or-

Baptist Medical Center
Bloodless Medicine & Surgery Program
(358 miles from Pensacola, Florida)
800 Prudential Drive
Jacksonville, FL 32207
Contact: Gary Butler
Toll Free# (800) 839-9161

Krista asks:
My mother has chordoma of the spine. Due to reglious beliefs she does not take blood. We are looking for a phyiscan to remove the mass. Can you take care of this?

Response:
Please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital. You can also request an appointment online.

Stacey asks:
I am reporting on bloodless surgery for a college class and would like to find statistics on these procedures; can you help me?

Response:
Please call 1-800-789-PENN (7366) and ask to be connected to Michael Columbus at the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital.

Lee asks:
I'm a Jehovah's Witness. Are there any bloodless centers near St. Augustine, FL?

Response:
Florida has an excellent bloodless center close to you (41 miles).

Baptist Medical Center,
Bloodless Medicine & Surgery Program - Jacksonville, FL

Gary Butler, Program Manager
800 Prudential Drive
Jacksonville, FL 32207
(904) 202-3460
(800) 839-9161

Mind asks:
How soon can you get hemoglobin to optimal levels for cancer surgery with the use of iron and erythropoietin?

Response:
It has been our experience that we can increase the hemoglobin one gram or unit per week.

Dan asks:
In the past, I have donated over 100 units of platelets. Where can I donate in the Philadelphia area, other than the Red Cross.

Response:
The Red Cross has two collection facilities in Philadelphia. One at 7th and Spring Garden, the other is at the Smiley Times Building near the corner of Rhawn Street and Route 1 in the Northeast. These sites are supplemented by mobile collection units that travel to community drives. Everything collected by the Red Cross is distributed to hospitals in the Penn-Jersey region as needed.

Abe asks:
What can you do if someone's platlettes are at three? Can something be done to increase the platlette count as soon as possible? Also, I asked my mom's doctor if a bone marrow transplant could be done without blood in a patient with (ALL) leukemia and his response was no. Is this true?

Response:
If available, Neumega, a blood growth factor that directly stimulates the proliferation of stem cells and produces an increased platelet production, should be used.

If Neumega is not available, hemostatic agents (product designed to stop bleeding) should be used.

Babs asks:
Do you have any suggestions to increase hemoglobin in a 91 year-old surgery patient who has had most of his colon and spleen removed and stomach ulcer clamped? It stays at 4.3 four days after surgery. A weekly shot of Procrit has been given, albumin, iron by IV and now iron pills by mouth. The patient is in Wisconsin, but because of an emergency was not able to get to a bloodless surgery hospital.

Response:
If there is ongoing blood loss, limit blood sampling (testing). Continue to check stools for ongoing blood loss.

Normally low EPO levels will occur after an operation. Maximize EPO dose to 60,000 per week. Add other vitamins (Folate Vitamin C and B Complex). It may take some time to come back to normal. A check of the reticulate will determine if the patient is producing red blood cells.

Paul asks:
Can a bone marrow transplant be done without blood?

Response:
In some cases, bone marrow transplants can be performed without blood.

Peripheral blood stem cell transplants (PBSCT) do not require blood transfusions, as demonstrated by the work at Pennsylvania Hospital by Patricia A. Ford, MD. A PBSCT requires that the patient have unwanted substances removed from the blood in which stem cells are collected. A few days prior to donation, the patient takes medication to increase the number of stem cells circulating in their blood. Thereafter, stem cells in the blood are removed and frozen for future transplantation; and the patient's remaining blood cells are immediately returned to the donor.

Evelyn asks:
I just wanted to find out if you can help an MS patient through stem cell transplantation and, if so, how we could go about it. If not, can you recommend a hospital that does?

Response:
We do not offer stem cell transplant for MS. Additionally, we do not know of anyone performing this.

KW asks:
Has Patricia Ford treated, with bloodless medicine, patients with AML who have gone into remission?

Response:
Yes, Dr. Ford has patients with AML that have gone into remission. Please note that only select individuals may survive. The sooner the treatment starts the better.

Carol asks:
My brother will need a stem cell transplant after more rounds of chemo. He has NON Hodgkins Lymphoma. Is yours the only hospital that has the capabilites to do this? Or can another hospital, say like the Mayo Clinic be able to do something like this with your guidence?

Response:
The Mayo Clinic could perform the stem cell transplant under the direction of Patricia Ford, MD, our Center's medical director. However, Dr. Ford is the only physician with a proven track record.

If you'd like to speak with Dr. Ford or schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Little Bear asks:
What will be available for bloodless surgery in the next two years?

Response:
There are very few procedures that cannot be performed without blood. In fact, today stem cell transplants are being performed without blood transfusions.

In the next two years, "bloodless" medicine and surgery will become the standard of care, and the need for allogeneic blood will be a rarity.

Ronald asks:
I have been told I need a TURP but would like to have a minimal invasisive procedure like a Trans Urethral Needle Abation. Do you offer this?

Joseph Harryhill, MD, FACS responds:
Dr. Terrence Malloy and I have been performing KTP laser prostatectomy procedures as a minimally invasive alternative to TURP. We find that removal of obstructing prostate tissue is much more efficient with the laser than using needle ablation (e.g. TUNA), and blood loss is minimal. (We've even safely done the procedure on patients taking Coumadin.)

The GreenLight KTP procedure, as it's called (check out patient info section on www.laserscope.com) does require anesthesia and is done in a hospital setting, as opposed to TUNA, which can be performed in the office.

If you'd like to speak to us further or schedule an appointment, please call 1-800-789-PENN (7366) or request an appointment online.

Larry asks:
My wife is scheduled for a hip resurfacing procedure. Her doctor is balking regarding the blood issue. Are you aware of any surgeons who perform bloodless hip resurfacing operations?

Response:
Dr. David Nazarian at Pennsylvania Hospital can perform this operation. Please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital. The Center will help you to schedule an appointment.

David asks:
My brother-in-law will require a bloodless liver transplant as soon as possible. We know of a facility or a doctor in California but are trying to find a site closer to our home in Atlanta, GA. What can you suggest?

Response:
A good contact for an east coast bloodless liver transplant surgeon would be Dr. Jean Emond at New York-Presbyterian Hospital/Columbia in New York, NY 10032.

Ryan asks:
My mother is requiring a bloodless liver transplant. Can you give me some contact information for centers close to Texas?

Response:
You can contact:

Jessica L. Varisco
Coordinator, Blood Conservation/Management Program,
Advance Directives Educator
Christus St. John Hospital
Transfusion Free Med/Surg. Program
18300 St. John Drive
Nassua Bay, TX 77058
(281) 333-8878

Ariane asks:
My mother has undergone two surgeries dealing with cancer. The first was for colon cancer, the second was for lung cancer. Both were successful, but now she has been told that she has a spot on her ureter and possibly one on the spleen as well. Her HB count is at 10 right now and she does not want to receive any blood. Since the spleen holds a vast amount of blood, is there a possiblity that the surgery will be a success? Please tell me there is hope.

Response:
Recent medical journals report that this type of surgery can be performed "bloodless." It would be best to find a surgeon experienced in laparoscopic surgery.

Abe asks:
My mom is a Jehovah's witness and was diagnosed with acute lymphoblastic leukemia (ALL). She is on her third chemo treatment. Are their survivors of this type of leukemia without blood transfusions?

Response:
There are survivors of ALL. Patricia Ford, MD, medical director of the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital, is the only known physician successfully treating ALL with stem cell transplant. Please contact the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital by calling 1-800-789-PENN (7366).

Lisa asks:
Is there any way to treat AML without blood or raise the hemogloblin level from 4.0 to a level where chemo can be used?

Response:
It is very difficult to treat AML without transfusion support and I suspect it can not be attempted in this case because of the initial low hemoglobin.

One special type of AML - M3 can be treated without aggressive chemo, but I am certain that this has been ruled out.

Francine asks:
Are there bloodless medicine techniques for deviated septum with non-malignant cysts?

Response:
A deviated septum is generally handled by an otorhinolaryngologist (ear, nose and throat specialist). Most of these procedures are low blood loss operations, although it depends on the size of the cysts. The best approach would be to contact a specialist. Dr. James Kearney is an otorhinolaryngologist at Pennsylvania Hospital. If you would like to make an appointment, call 1-800-789-PENN (7366) or request an appointment online.

Corina asks:
My mother will be having a leg bypass surgery soon. What can she eat and or drink besides iron tabs to build her blood before surgery, which will be done without blood?

Response:
For more information regarding what your mother can eat and drink before surgery, please refer to this page in our care guide.

Chico asks:
My wife needs a liver transplant and my oldest child has offered to be the donor. I have the problem of locating where we can do a bloodless liver transplant with a live donor.

Response:
St. Luke's Medical Center in Milwaukee can perform bloodless liver transplants. Contact David Van Thiel at (414) 385-2775.

Question:
Where can I have a lung transplant without the use of blood?

Response:
There are options available for lung transplants without the use of blood. Following is contact information for these programs:

Jessica Varisco at the Conservation Program in Houston, Texas has a number of physicians willing to perform bloodless procedures for lung transplants.

You could also contact Heidi Waitkus at the University of Massachusetts Medical Center. Her phone # is (508) 856-2715.

Zahara asks:
My friend who lives in Sacramento and has Kaiser must have a bypass surgery. She is a Jehovah's Witness. Kaiser is not being helpful in finding an alternative hospital for her to have her surgery. Can you send a listy of hospitals in California that might perform such a surgery. Many thanks.

Response:
Your friend should contact the Hospital Liaison Committee for Jehovah's Witnesses in Sacramento, CA. Try contacting Greg Brown, chairman at 916-988-4820 or Robert Hartsten at 530-524-7189.

Also, the following bloodless centers are located in California:

• Arcadia Methodist Hospital of Southern California
• Burlingame Mills-Peninsula Hospital
• Corona Regional Medical Center
• Fountain Valley Regional Hospital
• Orange Coast Memorial Medical Center
• Fresno Saint Agnes Medical Center
• Glendale Memorial Hospital and Health Center
• Inglewood Centinela Hospital Medical Center
• Lakewood Regional Medical Center
• Los Angeles Brotman Medical Center (CULVER CITY)
• City of Angels Medical Center
• Good Samaritan Hospital
• USC/Norris
• Madera Children's Hospital Central California
• Murrieta Rancho Springs Medical Center
• Orange Chapman Medical Center
• Palm Springs Desert Regional Medical Center
• San Diego Sharp Chula Vista Medical Center (CHULA VISTA)
• San Ramon Regional Medical Center
• Ventura Community Memorial Hospital
• Wildomar Inland Valley Regional Medical Center

Emily asks:
Is a liver transplant able to be done without blood?

Response:
A liver transplant can be performed without the use of blood. The patient's own supply of blood needs to be built up prior to the operation. The surgery is performed using techniques that best minimize blood loss.

Jodi asks:
I live in Charlotte, North Carolina, my 68 year-old mother needs a lumbarectomy. She is a Jehovahs Witness. Can you make referrals for doctors in my stata or would we have to come there?

Response:
For more information about doctors in your area that would perform a bloodless lumbarectomy, contact Gary Pelzer, Chairman of the Charlotte, North Carolina Hospital Liaison Committee at 704-382-6879.

Stacey asks:
What about patients that refuse any blood products. Will that include bovine-derived products such as floseal or is it patient dependant?

Response:
Bovine derived products are hemoglobin fractions. Therefore, it would be a matter of personal choice or personal conscience for a patient who was receiving bloodless care.

Theresa asks:
My mother in law is a Jehovah's Witness and her doctors want her to have radiation therapy for treatment of cervical cancer. They feel she is too high a risk for radical hysterectomy due to her refusal of blood products and the high risk for requiring transfusion with this surgery. However, she still wants the surgery. In general, if there is another bloodless treatment available do you still offer the high risk surgery?

Response:
Please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital.

Mark asks:
I have a 70 year-old friend who is a Jehovah's Witness. He was diagnosed with Myelodysplastic Syndromes. Do you have any information which may assist him with non-blood therapy?

Response:
Traditional treatment is through transfusion; however, there are growth factors that can be used for patients who prefer non-blood therapy. For more information, please call 1-800-789-PENN (7366) and ask to be connected to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital.

Skywalker asks:
Can you do a bone marrow transplant on a patient with CML and a mild case of Von Weillebrands disease?

Dr. Patricia Ford responds:
Von Weillebrands disease does increase the risk of bleeding. The patient would need input from a hematologist to determine bleeding potential and treatment for Von Weillebrands disease.

Rossie asks:
Can tricuspid valve surgery be done without blood?

Dr. Charles Bridges responds:
Yes, tricuspid valve surgery can be performed without blood. The approach to tricuspid valve surgery is the same as we use for all bloodless heart surgery. We have successfully repaired atrial septal defects through the right atrium using a bloodless technique and we use the same approach for repair of the tricuspid valve.

In many respects, the exposure is easier and therefore bleeding is likely to be less for tricuspid valve surgery than for the more commonly performed mitral or aortic valve surgeries, both of which we perform regularly using bloodless techniques.

Love asks:
I am a Jehovah's Witness. I have read that hemodilution and cell salvage varies in their procedure. What are the different types of hemodilution? Which type of hemodilution and cell salvage will go back right away to one's body when performed? Please let me know about this for further information on my decision in my DPA.

Response:
Each anesthesiologist and/or perfusionist may set up these devices differently.

Jehovah's Witnesses follow the biblical mandate (Deut. 15:23) which states that shed blood must be "poured out upon the earth." Therefore, what is important for the Jehovah's Witness patient is that any device be set up in a "closed circuit," thus avoiding the shedding of blood. This matter needs to be discussed with your anesthesiologist prior to surgery.

Bob asks:
What percentage of patients requesting Bloodless Medicine and Surgery at UPHS are Jehovah's Witnesses?

Response:
Ninety percent of our patients are Jehovah's Witnesses.

Leo asks:
What are some reasons a person would not be able to have a blood transfusions?

Response:
There are many reasons why a person would choose not to have a blood transfusion. Patients seek bloodless care due to religious, personal and ethical beliefs. Specifically, some patients are concerned about the risk of a contaminated supply or blood shortages.

Bukki asks:
I am in the ENT surgical training in Ireland. I'm very much interested in bloodless surgery, but it is not common practice here. Please I would like to know the transfusion alternatives available in ENT/Head and Neck surgery. For example in post tonsillectomy hemorrhage, thyroidectomy, neck dissection for malignancy. Do you have any experience in the ENT surgical management of Jehovah's witnesses?

Dr. James Kearney responds:
We try hard to control blood loss through careful use of cautery. We do not typically hemodilute. Our bloodless medicine program is very active in preparing patients preoperatively with iron supplements. They actively participate in the admission with the use of pediatric tubes for blood draws, limiting blood draws. I have never gotten to the point of needing to transfuse a patient in the program, so I am not too familiar with what alternative products they recommend for patients with critically low hematocrits.

I have learned from our program about the beliefs of Jehovah's Witnesses regarding blood transfusion. To take a transfusion means expulsion from the community and the loss of eternal salvation. If you are a believer it certainly makes sense to forgo transfusion to save your soul for all eternity. I respect the beliefs of my Jehovah's Witness patients and would not pressure them to accept a transfusion.

Response:
Dr. Michael Scherl of Englewood Hospital, Englewood, NJ, works closely with Dr. Boyer in providing quality ENT care. His areas of expertise include head and neck surgery and facial plastic surgery.

His web site (http://www.ent-facialplastics.com/) says: "We have been involved in a multitude of procedures at Englewood with the bloodless surgery program. Most recently we took part in a procedure to replace the scarred and dysfunctional esophagus in a patient from Vermont who had been refused bloodless surgical elsewhere. We have routinely performed bloodless surgery in pediatric and adult patients through the program."

Many bloodless centers in the United States have surgeons on staff who routinely perform ENT surgeries.

Greg asks:
Just curious about someone with hemophilia, how would your center or staff recommend treating it without the use of blood transfusions?

Response:
We use the product NovoSeven, a recombinant (genetically engineered) factor VIIa product, to treat bleeding episodes in hemophilia A or B patients.

Leo asks:
What are some alternatives to blood transfusion to build hemoglobin? Where could I find some detailed information concerning this subject?

Response:
Erythropoietin is the name of a chemical normally produced by your body, primarily by your kidneys. Erythropoietin stimulates the bone marrow to produce red blood cells. Laboratory-made synthetic erythropoietin helps.

You may also use iron supplements, such as ferrous sulfate or ferrous gluconate. Take these supplements with vitamin C (e.g., swallowing the iron pill with a glass of orange juice). The vitamin C helps your intestine absorb the iron more effectively.

You can find more information about this subject by reading about preparing for bloodless surgery.

Question:
What bloodless techniques can you use on neonates and small children of Jehovah's witnesses? Do you have any case studies?

Response:
There are all different types of alternatives for neonates. What is the medical condition that you need an alternative for?

Ned asks:
With a diagnosis of cancer, does bloodless surgery become more complicated. Are there any suggestions as to treatment options, i.e. withold chemotherapy. Do you have any specific information or refences that relate to cancer and bloodless medicine?

Response:
Bloodless surgery does become more complicated with a diagnosis of cancer. Regarding treatment options, every attempt should be made to maximize blood.

Suzie asks:
My mother has an aneurysm on her aorta and needs a aorta replacement. She is a Jehovah's Witness. Where should we begin to find someone who will perform the surgery? We live in Johnstown, PA.

Response:
You can contact us at:

Center for Bloodless Medicine & Surgery at Pennsylvania Hospital
700 Spruce Street
Suite 102
Philadelphia, PA 19106
Phone: 888.451.6060

Patricia A. Ford, MD, Medical Director
Michael J. Columbus - Administrative Director

In the Pittsburgh area, you can contact:

Center for Bloodless Medicine and Surgery
Allegheny General Hospital
320 East North Ave
Pittsburgh, PA 15212-4772
Phone: 877 284-2100

Danielle asks:
I am a Jehovah's Witness who would like to become a registered nurse. We do not accept blood transfusions for biblical reasons. Is it possible to be an RN and never have to administer a blood transfusion?

Response:
There are many Jehovah's Witnesses who are both registered nurses as well as physicians. The tenants of the Jehovah's Witness faith do not prohibit the clinician from administering blood or blood products.

From a human resources perspective, nurses who are Jehovah's Witnesses and are troubled with administering blood may request a different assignment.

Larry asks:
My mom has been diagnosed with myelodysplastic syndrome. I don't quite understand everything about this. She is in the hospital now so if you have any information on this please let me know.

Response:
Myelodysplastic syndrome is a bone marrow disease that results in very low blood counts, anemia, infection and bleeding. Traditional treatment is transfusion. However, there are growth factors that can be used for patients who do not want blood transfusions.

For more information, please call 1-800-789-PENN (7366) and ask to be directed to the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital.

Ucheche asks:
I am a 30 year-old lady with sickle cell anemia. I also have gall bladder stones which I want to remove in Los Angeles county at the USC University Hospital because of complications in Nigerian hospitals and their lack of facilites. How do I get a doctor and address the cost of treatment and visa before December 31, 2004?

Response:
Below is contact information for USC University Hospital:

Randy Henderson, Manager
USC University Hospital -
Bloodless Medicine and Surgery Program
1500 San Pablo Street
Los Angeles, CA 90033
Office: (800) 872-2273
Office 2: (323) 442-5261
Email: randy.henderson@tenethealth.com

Tuck asks:
I am a 42 year-old woman with sacardosis. My lungs are scarred and it has been suggested to me that I can have a lung transplant done without blood. I am a Jehovah's Witness. I also have liver problems and in the future might need to have a liver transplant, too. Are these two surgeries possible?

Response:
Only one lung transplant has been performed in the United States without blood. Another one has been done in Europe. Liver transplants without blood are more common, but remain rare.

• For a lung transplant, we would suggest contacting the
  University of Southern California.
• For a liver transplant, consider the University of Pittsburgh.

Since you are a Jehovah's Witness, we would also recommend that you contact your HLC (Hospital Liaison Committee). You can do this through your local congregation. The HLC can communicate your needs to HIS (Hospital Information Services) in New York who would be happy to further assist you.

Shelva asks:
For children who have sickle cell and need surgery, can they use the cell salvage or hemodilution?

Response:
A sickle cell patient can have cell salvage and hemodilution, however it is not optimum. One course of Hydroxyurea (chemotherapy) along with Procrit would be more effective, if the patient had the time prior to surgery for the treatment.

Lesley asks:
My mother died about a year and a half ago. She had a rare form of anemia. Hypoplastic anemia or mylodisplastic syndrom. She was in remission for about 7 years and all of the sudden her hemoglobin levels started to drop, and The doctors were aware of this in Jan of 2003, however they did not know what to do since she was one of Jehovah's witnesses and would not take blood. They found an alternative treatment of some syrum that would suppress the immune system to supposedly stop it from attacking her blood cells. They told us that a bone marrow transplant was impossible without a blood transfusion.. Am I to believe that they lied to me and you all have been doing it successfully? Her Hemoglobin was a 7 in January, and they did not come up with this alternative treatment till the end of Feb too late when she checked in for it she was at 3.6 and deteriorated within the next week and a half.. Please tell me what could have been done in her case.

Response:
Patients with Myelodysplastic disease often have a course similar to your mother's with a stable chronic phase followed by profound anemia and eventual death from complications of low blood counts. They are typically given supportive care with transfusions - Procrit rarely works.

There are many types of bone marrow/stem cell transplants. We do autologous which is not appropriate for this disease. Allogeneic transplant is considered only for young individuals with a match and has not successfully been done without transfusions to our knowledge.

Amy asks:
Suppose that someone who is a Jehovah's Witness is in an accident, loses a great deal of blood, and desperately needs it as soon as possible. What alternatives to blood could be given? And what are the odds that these options would work?

Response:
The first step is to stop the bleeding. The body has a finite amount of blood running through the veins. However, if a patient is losing blood there is only so much time before the patient reaches a critical condition. At 25% of lost blood volume (about 1.2 quarts) the patient can be experiencing shock and organ perfusion problems. At 50% lost volume (about 2.5 quarts), the patient is at a high risk for serious morbidity or mortality.

Managing the volume is another key factor in caring for the patient with acute blood loss. Determining which resuscitation fluid is best depends upon the condition of each individual patient. Some doctors opt for a crystalloid solution while others prefer colloid solutions. In most cases, crystalloids are typically best for lesser blood volume replacement due to their ease of use and availability.

Bleeding that occurs into the abdominal cavity such as from a ruptured spleen, or into the lung cavity, can many times be recirculated back into the patient. A technique known as red cell salvaging, most commonly used during surgery, can be used in such cases. The red cell salvaging device is able to suction up the blood that has bled out, wash and filter the blood, and then return the red blood cells back to the body. This can also be accomplished in some cases of fractures of the femur and other areas where blood can pool.

In one review of emergency management of patients who refuse blood products, such as Jehovah's Witnesses, there has been a marked improvement when a more aggressive approach to management is taken. In one report, the mortality rate was 75% for individuals in cases where management was conservative; however, when immediate surgery was performed within the first 24 hours and every effort was made to limit blood loss, the morality rate dropped to only 20%. This aggressive approach has proven effective in avoiding the use of blood in emergencies.

Barbara asks:
My baby is 7 months old and his diagnosis is recurrent coarctation of the aorta and left ventricular outflow tract obstruction. Pretty soon he will be having surgery. They're going to repair the coarctation of the aorta and the left ventricular outflow tract obstruction. Before surgery he will also have a catherization and aortic balloon angioplasty. Is it possible to have all this done without blood? How complicated is my son's surgery without blood? Is there a doctor that practices bloodless medicine at DuPont Hospital for Children?

Response:
Please call 1-800-789-PENN to discuss your question in more detail. Ask to be connected to Mike Columbus at the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital.

Scott asks:
I would like to know if Polyheme would be acceptable for Jehovah's Witnesses? If so I think this is fatastic news.

Response:
The development of PolyHeme presents a new option to people who prefer not to receive blood transfusions. Jehovah's Witnesses may accept "fractions of any of the primary components of blood", opening the door to the use of hemoglobin-based blood substitutes like PolyHeme. PolyHeme is a matter of personal choice for those who choose not to receive blood because of religious beliefs. The decision for Jehovah's Witnesses lies with each congregant.

Patricia asks:
Our brother is diagnosed with acute myelogenous leukemia. Do you treat this? What would the prognosis be?

Response:
The Center for Bloodless Medicine and Surgery at Pennsylvania Hospital does treat acute myelogenous leukemia, however, there are centers in Florida that treat this condition as well.

Below is contact information for those centers:

Bloodless Medicine & Surgery Program
Baptist Medical Center
800 Prudential Drive
Jacksonville Fl 32207
(904) 202-3460 Local
(866) 839-9161 Toll Free

Gary L Butler, Program Manager
John M Crump, MD, Medical Director

Center for Bloodless Medicine and Surgery
Jackson Memorial Hospital
1611 NW 12th Avenue
Miami, Florida 33136
1-800-NO-4-BLDD (1-800-664-2533)
(305) 585-7269

L. Diane Mitchell, M.S.W., L.C.S.W, Coordinator BMSP
Mitchell@um-jmh.org

Center for Bloodless Medicine and Surgery
Tampa General Hospital
Davis Islands
P.O. Box 1289
Tampa, FL 33606
Voice: (813) 844-7807
Toll Free: (866) 662-5333
Pager: (813) 332-7807
Fax: (813) 844-4225
Email: Ratkins@tgh.org

Medical Director:
Thomas L. Bernasek, MD
Vice Chief, Orthopaedic Surgery

Coordinator:
Robin Atkins, MPH, MSW, LCSW

Nicole asks:
Are there any alternatives to a blood transfusion for a sickle cell patient (age 5)?

Response:
As alternatives to blood transfusions, intravenous fluids, oxygen, antibiotics and other medications are often given to help minimize the complications experienced by sickle cell patients. Also, there are a number of medications being tested. For example, researchers have been experimenting with the use of inhaled nitric oxide for patients experiencing the complications of sickle cell disease. Nitric oxide is a colorless, odorless gas. It is sometimes used in respiratory therapy to open up or widen the blood vessels of the lungs and improve the flow of blood through the vessels. Although it does not cure sickle cell disease, this has helped some patients by reducing the frequency of painful crises and episodes of acute chest syndrome. There has been some concern about the possibility of this drug causing leukemia, but there is no definitive data that nitric oxide causes leukemia in sickle cell patients.

Newer drugs are being developed to manage sickle cell anemia. Some of these agents try to induce the body to produce more fetal hemoglobin (therefore decreasing the amount of sickling) or by increasing the binding of oxygen to sickle cells. Currently, there are no other widely used drugs that are available for treatment.

Bone marrow transplants are currently the only potential cure for sickle cell anemia. In this treatment, the patient's bone marrow (which makes the sickled red blood cells) is replaced with bone marrow from another individual without sickle cell disease. However, it is difficult to find the right bone marrow donor, and the drugs needed to make the transplant possible are highly toxic. Also, bone marrow transplants are much more expensive than other treatments and require blood transfusions. Gene therapy may be the ideal treatment, but it has proven to be very difficult in humans.

Nora asks:
My daughter is twelve and suffers from mild anemia. She comes
home very tired and refuses to eat liver. How can I help her?

Response:
Your daughter should see a physician to determine the underlying cause of the anemia. View our page on Preparing for Bloodless Surgery. This site offers suggestions on how to build up hemoglobin levels.

Nicole asks:
How many patients have you lost because of their refusal to take blood?

Response:
Patients seek bloodless care due to religious, personal and ethical beliefs. By choosing medical care without the use of blood transfusions, patients benefit in many ways. Overall, patients who choose bloodless care have a better outcome, due to the avoidance of transfusion complications and reactions. Patients will also have a shorter hospital stay.

Nicole asks:
I am a jehovah's witness. I am actually working on a speech now on alternatives to blood transfusion I was wondering if there is a Bloodless Center in or near Illinois?

Response:
There is a bloodless medicine and surgery center in Chicago, Illinois. Below is the contact information:

Jan Castro Graziani
Bloodless Medicine and Surgery
Swedish Covenant Hospital
5145 North California Avenue
Chicago, Illinois 60625
1-773-878-8200 EXT. 1826

Question:
Does your hospital do bloodless liver surgery? I am looking for a hospital as close as I can from MD. If you know of a hospital that will do bloodless liver transplant please let me know. I could use ANY help.

Response:
Our hospital does not perform bloodless liver transplants.

The best choice is:

USC University Hospital
Randy Henderson
Coordinator
1500 San Pablo Street
Los Angeles, CA 90033
(800) 872-2273

They have done 22 bloodless liver transplants.

Allegheny General Hospital in Pittsburgh also performs liver transplants:

Allegheny General Hospital
Perry Doebler
Coordinator
Center for Bloodless Medicine and Surgery
320 East North Ave.
Pittsburgh PA 15212-4772
(877) 284-2100

Question:
If a patient is anemic, what other alternatives can be given to that patient that do not involve blood transfusions?

Response:
If a patient is anemic, erythropoietin injections and iron are other alternatives that could be given to the patient and do not involve blood transfusions. Erythropoietin injections cause your body to make more red blood cells, and therefore boost your blood count. Iron stimulates the erythropoietin to take effect.

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.