Thursday, July 7, 2016

Advances in Blood Medicine



When a patient refuses chemo-therapy or radiation therapy, you may occasionally see it referred to as “life-saving” chemo or “life-saving” radiation, but usually not.

Why not? Because most readers know that chemo or radiation may or may not be life-saving, and that rejecting one or the other doesn’t mean the patient has opted to end their life; it may simply mean they have chosen some other treatment.
But when a patient declines a blood transfusion, the media almost always suggests that the patient is some kind of nut-job for refusing a “life-saving” blood transfusion… usually with a lot of exclamation points!

After years of rebelling against whatever those in authority told me I was supposed to accept, I’ve learned a lot about those“life-saving” blood transfusions.
Did you know, for example, that:
The American Medical Association…recently identified RBC [red blood cell] transfusions as one of the top five overused procedures in medicine, defining overuse as ‘circumstances where the likelihood of benefit is negligible or zero, and the patient is exposed to the risk of harm.’”
That can’t be right; “negligible benefit” and “risk of harm”? Don’t all doctors take an oath that says “First, do no harm”? Why would this highly respected body, the American Medical Association, say such a thing about a supposedly “life-saving” procedure?

Decades ago, the biggest fear from a blood transfusion was mismatching. Give a patient the wrong blood type and the results could be fatal. Then it was discovered that diseases could be spread by blood transfusion. Today, the known contagions spread via transfusion are:
  • HIV/AIDS
  • Hepatitis
  • “Mad Cow Disease” (Variant Creutzfeldt-Jakob disease)
  • Babesiosis
  • Lyme Disease
  • West Nile Virus
  • Syphilis
  • HTLV-I and II (viruses associated with leukemia)
  • Zika
"Known" contagions because:

  1. All the diseases on the above list, from AIDS on down, were at one time unknown, and initially transmitted by blood transfusion in large numbers before blood banks even knew they should be testing for them... and new diseases appear all the time. When I originally wrote about this three years ago, Zika wasn't even on anyone's radar.
  2. Even with known diseases there can still be a "window period" of up to 45 days after a donor has contracted a disease wherein his blood may pass it on, undetected until it is too late.

However, while the incidence of patients catching a disease from a blood transfusion is higher in Third World countries, the risk everywhere has dropped markedly: one benefit of the AIDS epidemic has been better methods of testing blood.

With all that, this is not the “harm” that the AMA was talking about. If you Google 'risks from blood transfusion' you'll find that the medical community as a whole is convinced that the risk from mismatched blood or blood-borne disease is microscopically small.
So perhaps the AMA was referring to this:
“In a study of 5,065 patients who underwent [heart bypass surgery] …blood transfusion [was found to] be associated with adverse postoperative neurologic and renal (kidney) outcomes.” - Journal of Blood Transfusion
Or maybe this:
“A growing body of evidence suggests that [storage of donated blood] may reduce tissue oxygen availability, have proinflammatory and immunomodulatory effects, and influence morbidity [illness or injury] and mortality [death].”  - Blood Transfusion Magazine
Well, that one’s a little complicated. How about this:
Blood transfusion is inherently unsafe; it is accepted that some disease and deaths will occur from the act of transfusion… A large number of recent (within the last 7-10 years) studies have shown a profound association between transfusion and adverse outcomes. Very few articles have been published showing a relationship between transfusion and improved outcomes. Today there is mounting evidence that patients who are transfused do worse than patients who are not.” - Professor Bruce D. Spiess, MD.
The rationale for blood transfusion is obvious: if your car begins leaking oil, your mechanic will fix the leak, then replace the lost oil.

However, your body is more complicated than a car, and blood is more complicated than oil. And, hopefully, your doctor doesn’t think he’s a mechanic.

How, exactly, does blood work? Why do doctors so frequently resort to blood transfusion if, as Dr. Spiess points out, blood transfusion "has never undergone efficacy and safety testing the way in which a drug would be tested for approval by the US Food and Drug Administration.”

In the rest of this series we’ll discuss the most common justifications for blood transfusion – its oxygen-carrying ability and its clotting factors – and the fallacy of both those beliefs. And the very real threats that even ‘safe’ donor blood pose to patients. We’ll also look at advances in blood alternatives, as well as new treatments for traumatic blood loss that have come out of the Iraq/Afghanistan wars.

This is critical information. Pass it on to all your friends. It could actually be “life-saving.”



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