Word: shander
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...patient's own drawn blood is held for use after surgery. In another technique, doctors may use albumin, a protein found in plasma that is acceptable to many who refuse transfusions on religious grounds, to maintain or increase blood volume, or to manage an underlying medical condition. Says Shander: "They used to tell us, 'Give 'em a couple of bottles of blood--it won't hurt; it's good for what ails them.' Well, that might be easier, but I've learned to rely on less, with better results...
...especially difficult case that Shander oversaw at Englewood, 11-year-old Cristali Rodriguez came in with a rare pancreatic tumor, one of only 300 documented cases worldwide. Doctors in Philadelphia had declined to perform a Whipple procedure, a complex reconstruction of the digestive tract rarely performed on a child. Rodriguez's parents had refused a blood transfusion, and the girl's doctors felt that without it the operation was even more risky. Undeterred, Englewood surgeons did a 10-hour bloodless Whipple. There were no major complications, and a week later Cristali was eating pizza. Soon after her discharge...
Other factors make bloodless surgery increasingly attractive. Transfusions can suppress the immune system, for example, leaving a patient open to infection, slower healing and a longer recovery time. "Also, banked blood, after it's cooled and stored, doesn't have the capability of fresh blood to transport oxygen," says Shander. "We're just beginning to understand what it is we do when we give a transfusion." Finally, there is the cost: at around $500 for each transfusion, plus administrative add-ons, the total bill comes to between $1 billion and $2 billion annually, more than enough incentive to consider alternatives...
...Shander is not put off by such fears. "Medicine is very conservative," he says, "which can be good, since it protects doctors against going along with every unproved technique that comes along. But it's imperative that we develop a mind-set where we look at refusing blood not as an obstacle but as a challenge...
...Shander, the problem is a more personal one. "When we're challenged, we extend ourselves," he says. "Some of my colleagues have adopted bloodless medicine purely as a technique. Others have learned that it also has an impact on ethical and humanistic values. I feel that once you become philosophically committed to practicing bloodless surgery, the benefits to patient and physician alike become more and more apparent. Those are my greatest rewards...