Can this surgery be done without giving blood transfusions?

I don't believe I needed any blood.

My family donated for me a week before my surgery, but I was anemic (and I did get the two units they'd put aside), and my surgery back then was done "open" rather than laparoscopically (more risk for blood loss, on top of things). But I don't think it's routine to give blood prior to this surgery, unless you're very low or symptomatic.

As a nurse, when I started, EVERYONE wanted a hemoglobin of 10 at my hospital, back in 1994... now, you can be 7.5 and they'll hem and haw whether to give you blood, and may not, if you're not symptomatic. I think they've learned over time that the more exposure to blood products, the more issues because of exposure to other antibodies, etc., so they're less likely to go there right away.

This is something you will need to discuss with your surgeon, as unexpected complications can and do arise. The colon has a lot of blood vessels and you can potentially lose a lot of blood during the procedure. I required 2 blood transfusions after my surgery, but I was quite ill with UC and had already lot a lot of blood (post opt my hemoglobin was a staggering 5.2). I also required a plasma transfusion before the surgery. Plasma is a blood product and would carry many of the same risks as a blood transfusion.

That being said, you can self donate prior to surgery, if you well enough going in.

Thanks for the quick reply.

The problem is I don't want to accept any blood transfusions what so ever and would like to go with alternatives if surgery ever had to happen.

quote:

The problem is I don't want to accept any blood transfusions what so ever and would like to go with alternatives if surgery ever had to happen.

Again, this is something to discuss with the surgeon. I'm sure they cannot guarantee you won't need one, but if you have strong reservations against it for personal or religious or any other reason, then you need to make this known and understand possible alternatives and their risks.

I agree you can't say for sure you won't need one - I didn't though.

If you are healthy enough and have enough time, you could donate your own blood. My dad did this for his prostate surgery. Or, have family donors as suggested above.

Here's the problem. This surgery has a higher risk of a need for transfusion than most others. That is because for the rectal dissection, there is a dense network of blood vessels down there. Sometimes uncontrolled hemorrhage is a result, regardless of the care taken. While they can do pretty good with volume expanders that are not blood products, they ONLY provide blood volume support, NOT any oxygen carrying capacity. Even plasma is a blood product.

If you are opposed to any sort of transfusion, you may find it difficult to find a surgeon to do this outside of an emergency, other than a simple colectomy with ileostomy. But, if you are OK with autotransfusion and are healthy enough, then you can donate your own blood in advance to be used on you alone.

Another option available (particularly in cardiothoracic surgery centers and trauma centers) is intraoperative cell salvage. This requires a special machine that harvests the blood from the operative field, cleans it, and preps it for reinfusion "on the go." This is something you can discuss with your surgeon to see if it is available at your hospital. But, again, you have to be open to transfusion of your own blood.
http://en.wikipedia.org/wiki/I...rative_blood_salvage

Hope this helps.

Jan

I was also going to suggest an autologous donation. Since it comes from you it doesn't need to go through rigorous testing. I did this for one of my surgeries. The only negative is that if you don't use your blood it is discarded because of that 'non' testing.

kathy

I needed a blood transfusion after my first surgery. I was really sick going into it and anemic. Blood loss from surgery just made it worse. That was my 4th blood transfusion so it was no big deal for me. Nope, no guarantee you won't need one so that makes things tricky if you do not want to accept one.

There is no way I can accept either my own preserved blood or someone elses.

Can't they just use some sort of fillers (saline) and/or iron infusions? When I'm anemic I get iron infusions and my HB goes up.

I'm open to alternatives as long as it doesn't require me to use blood of any kind.

I wonder if someone went through this and has some suggestions what's out there? Of course it depends on each doctor but I'd make sure that I see one who will be willing to work with me. Just wonder if it's even possible. I know some said it was possible for them but I just want to be prepared because having ulcerative colitis I cannot let surprises happen.

One time a doctor approached me telling me I needed blood (HB was 7) but I told him no. He was very oldschool. I went to my GI and told him I'm having a low blood count so he put me on an iron infusion. I felt great after that.

I'm just curious. What is the issue with receiving blood? I realize this may be too personal. If it is, please tell me(:

Andrina,

It's an interesting predicament you are in. That being said, there aren't many options other than what has already been listed here. Iron infusions may help, but keep in mind that iron infusions don't REPLACE blood. If you lose a lot during surgery, an iron infusion would probably be minimally helpful in the short term.

At this point, I think your best course of action is to talk to your GI and potential surgeon about your concerns. At this point, these are medical questions that should be directed to your doctor. Since you are refusing a blood transfusion under any circumstance, you need to make this a clear term going in, and make sure you have covered all possible bases with the surgeon as far as alternatives go. I agree with Jan that you may be turned down by some surgeons on these grounds so you must be prepared to up front from the outset. After all, this isn't something that can be remedied the day of surgery. I would imagine a feasible "back up plan" would have to be in place for you in advance so that any potential complication can be immediately and appropriately dealt with as it arises.

I hope you can find a reasonable solution. Even without surgery, just having UC, there may be times that your blood count is so low that a blood transfusion may be recommended, so you should already have viable options in place, IMO.

An iron infusion isn't going to cut it. That's just putting iron back into your body not blood. If you have blood loss that is significant in any way from the surgery, you will need that blood replaced.

If my surgery went the way it was supposed to in a 2 step laparoscopic I would of not needed a blood transfusion at all. The reason I got a unit of blood is because I needed an emergency surgery which had to be open in between my two surgeries due to a twisted intestine and I started leaking bile into my body my whole right side was green. That wasn't to scare you that was a very rare situation but that is the only reason I needed a transfusion because they opened me up and I lost a lot more blood and was in the ICU. After all my surgeries were done and I was home my red blood count was consistently at 7.5 and they wouldn't infuse me that is supposed to be a normal number after surgery and that is half of what it should be. I wouldn't be worried but I sure would ask my surgeon as many questions as possible so you understand everything. Good luck.

I think you are unlikely to be able to find a surgical team that will operate on an elective basis if you won't give consent to receive blood. I hate to be harsh but I have "friends in the biz" and they all agree.

If you were to end up needing emergency surgery, in the absence of an advance directive, you would be given a blood transfusion if medically necessary.

Although having UC and possibly needing surgery certainly increases the likelihood of requiring transfusion, the truth is that you could be hit by a car walking down the street tomorrow and end up in the hospital receiving an emergency transfusion. If you truly would rather die than receive blood (and I'm not making a value judgment -- I'm just laying it all out here) then you should have an advance directive (similar to a "do not resuscitate order") stating that you do not wish to receive blood transfusion under any circumstances.

I agree that you should be sure to have an advance directive on file with your doctors, hospitals, and family, so there is no question about your wishes. You can plan for a surgery down the road, but not your everyday type trauma emergency.

Iron infusions, erythropoitin, and other preoperative strategies to increase your circulating blood are good (if you have time, since it takes about a month to make enough blood). But, it does not deal with the instance of sudden hemorrhage, which is often fatal without proper treatment.

Even if you cannot accept even autologous transfusion, you might be able to accept the notion of cell-saver technology, that returns the blood to you as you bleed. Please look into it as an option (if available in your area).

Here is a link to an article that discusses the issues and possible solutions:
http://ceaccp.oxfordjournals.org/content/4/2/35.full

Good luck, and good for you for trying to do advance planning!

Jan

I had Jehovah's Witnesses with HGB as low as 4.8, which is crazy low, but they were absolutely not surgical candidates (they were medical patients only). Iron infusions do not give volume, and if you're bleeding out, you need packed cells, plasma, and cryoprecipitate. Faced with a low hemoglobin, dumping loads of *just* fluids in you will not fix your problem, IF you are faced with life and death hemmorrhaging. It will just dilute what you have, and have its own set of issues (certain fluids in bulk can increase acidemia, etc.). I think I DID read JW can accept cell saver blood, as Jan said, but the physician would have to be in the know and prepared for that with you.

And yes. Truth is if you WERE a trauma patient who came in hemmorrhaging, you're going to get blood. Even if you have an advance directive, they might not know, you might not have a card on you when it happens, etc.... though it's still good to get that in order, just in case.

Spooky's answer is pretty much what I'd say, otherwise. I agree with her.

I am Jehovah's witness and am in the same situation. I was able to have the surgery without any blood transfusions. As they have said here just make sure you have your advanced directive and that all doctors present in the surgery know about it. My anesthesiologist had a fit when i told her about it but she said if thats what i want then thats what she had to do legally due to my advanced directive.

I do have my note on me at all times which states I'm not receiving blood. I gave my GI copies as well before every colonoscopy in case they perforate my colon.

A friend of mine did her colectomy with saline and iron. She did just fine.

I could look into the cell saver. When the surgery is laparoscopic you shouldn't be losing too much blood, is that correct?

Thanks all for your replies. I know this is a sensitive topic and I appreciate your input.

The incision is not where you bleed. It is internal, where they remove the rectum (at least that is the most risky place). So, laparoscopy may not make that much difference. In all likelihood, transfusion won't be necessary anyway. It is not a typical thing. The banking of blood is more of a precaution than a "need." But, you need to have it all planned out in advance for the contingencies.

I was not adverse to transfusions, but wanted designated donor blood (because I was too sick to donate for myself). I went through surgery fine, although got pretty low in my blood counts. It was the complications afterwards, with a presacral abscess and further dropping of my hemoglobin that caused me to need transfusions. And wouldn't you know it? It was the day after the designated donor blood expired and got tossed! So, I wound up getting anonymous donor blood anyway.

We all have to choose our own paths, and who are we to decide what is right for you? The main thing is that your surgical team is on the same page and you are willing to assume the risks.

Jan

It's often tricky to effectively assess risks. In this case the surgical risk of death would change from negligible to quite real, and the risk of serious complications would also rise. This would be chiefly influenced by the specific risk (for a given surgery) of severe or uncontrolled bleeding. Some surgeons will be willing to let you assume that risk, while many others will perceive it as unacceptable. No surgeon likes it much when a patient's choice creates a surgical failure.

Every surgery is considerably riskier when it must be undertaken under adverse conditions. When life-saving tools cannot be used, whether because they're unavailable or because they're forbidden, lives really will be lost and damaged more often. Most of us feel differently about risk after it bites us, and is no longer abstract.

If a blood transfusion is really a no-no for you, you should take a marker and write that on your torso before surgery. I know this sounds ridiculous, but even if it's not likely to happen, mistakes are sometimes made (like operating on the wrong knee).

I looked up Jehovah's Witnesses and blood transfusion and now I'm confused. It says that pre-operative autologous blood is prohibited but that transfusions of autologous blood as part of a "current therapy" IS permitted. I guess I don't see the difference. Does this mean if one prepares ahead of time for a possible transfusion it is not permitted but one can have an autologous transfusion while being operated on? It was also interesting that the prohibition on blood transfusions was only introduced in 1945.

kathy

Yes, it is something about having the blood removed and stored that makes it contaminated. Not sure that is the proper word, but you get my drift. The "current therapy" thing is for non-blood cell components, like clotting factors, albumin, that sort of thing- to treat a specific disease with your own blood components, but not a transfusion with blood cells. Cell-scavenging, like I described with cell-saver technology, during a surgical procedure is allowed, I believe because it is kept in "circulation" with the blood stream, and not removed and stored.

It is all very confusing, but it is to conform to a specific Bible quote. One nice thing is that you are only disassociated from the faith if you voluntarily have a transfusion. So it is OK if it is done while you are unconscious and the providers did not know (maybe the note in your pocket or wallet got destroyed with your clothes, or stolen, whatever). If that happens, it had nothing to do with your faith.

Jan

Thank you for the explanation Jan.

kathy

I have had a couple dozen abdominal surgeries and only need 1 transfusion (step 2 of k pouch) due to rather unexpected complications that had nothing to do with the surgery itself directly (I woke up in the middle of surgery and went into shock...consequently I needed blood)...if not, they never had to transfuse me and they did a lot of work in there...it isn't a bad idea to stock blood if you are really scared as long as it can be used for another patient if (hopefully) it is not needed.
Sharon

They do not give your blood to someone else if you don't use yours. Mainly, it is because they designate it to you, and even if you don't use it during surgery, you may need it within that 30 days or so that it is viable.

I know, seems like a waste.

Jan

Really is a waste...Darn.
No way to donate it if you don't need it? Seems dumb for it to litterally go down the drain.
Sharon

Well, the thing is that once it is designated, it is designated, and does not go through the same rigors. Plus, say you were able to give it away, and the next day something happened that you needed a transfusion? You'd be up **** creek. Happened to me. The day after my designated blood was tossed, I needed a transfusion. But, I wasn't up any creek, I just used anonymous donor blood. I was fine.

Jan