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Understanding Blood and Blood Components

Bloodless Chart

Learn more about blood and 'minor blood fractions' with this helpful interactive chart.

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Bloodless Medicine

Re-operative Coronary Bypass Surgery

AGH Saving Lives with Bloodless Surgery

By Dana Peterman

James "Tyke" Allen is a 67-year-old retiree from Moundsville, W.Va. This past February he suffered a heart attack, his second since the 1970s. Within a week, he underwent a reoperative coronary bypass surgery performed at Allegheny General Hospital and has been recovering well.

What makes Mr. Allen so special is that he, as one of Jehovah’s Witnesses, will not accept a blood transfusion. Thankfully, AGH was prepared and able to save his life through the Center for Bloodless Medicine and Surgery.

"Bloodless Medicine is a good example of how AGH is trying to conserve blood and blood products in surgery," said George J. Magovern, M.D., chairman, Department of Thoracic and Cardiovascular Surgery, who operated on Mr. Allen. "We are trying to keep up with blood conservation and maintenance, so the less blood we use, the better."

In Mr. Allen’s case, no blood could be used at all. Due to the fact that he had open heart surgery performed by one of the first bloodless programs in the country thirty years ago, the resulting scar tissue increased his risk of bleeding more profusely during surgery.

To stop the bleeding, Dr. Magovern performed the surgery and packed his chest with gauze to aid coagulation, a concept similar to applying pressure to a paper cut to stop the bleeding, just on a much larger scale. As a result, Mr. Allen’s blood loss was so minimal that a transfusion would not have been necessary even under restriction-free circumstances.

Bloodless surgery was in its infancy when Mr. Allen underwent his first heart surgery, and its necessity has grown exponentially in modern medicine, especially since transfusions can be hazardous in their own right.

Which is why, along with decreasing levels of blood and blood product reserves, Dr. Magovern and his colleagues try to view every patient as a potential bloodless medicine candidate.

Not every patient is eligible, however, for this type of bloodless surgery. Several conditions, like the presence of scar tissue resulting from previous surgeries as in Mr. Allen’s case, can indicate a patient who is at a greater risk of bleeding.

"Underlying coagulation problems, such as a low platelet count, can also lead to increased blood loss, which is why coordination with a hematologist is essential for determining a patient’s candidacy for bloodless surgery," said Dr. Magovern.

Along with Hematology, Dr. Magovern worked closely with professionals from the Departments of Anesthesiology and Cardiology as well as a team of nurses, cardio thoracic house staff members, ICU personnel and physician’s assistants.

In other departments at AGH, transfusions are becoming less common in an attempt to conserve area blood reserves and avoid the risks associated with this particular type of therapy. Transfusion rates for major procedures are low in areas such as Colorectal Surgery, Oral and Maxillofacial Surgery, Surgical Oncology and Trauma Surgery, among others.

"I want to give my appreciation to all the departments who were involved in my surgery for their excellent care," said Mr. Allen.

Important advances in bloodless surgery have been made over the past decades but, for the time being, transfusion therapy will still have a place in the operating room. For more information on bloodless medicine visit the AGH Center for Bloodless Medicine and Surgery online.

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