Bloodless

Background

Blood transfusions are currently one of the most performed medical procedures in the world. However, the medical literature shows a relationship between the use of allogeneic (donated) blood and greater complications, including,  greater mortality. Worldwide, there is a deficiency in medical knowledge about transfusion practice.

Strategies for the conservation (management) of the patient’s blood (Pacient Blood Management – PBM), in the area of Transfusion Medicine, have shown, through impactful scientific publications, a better clinical outcome, with reduced morbidity and mortality for patients and costs for the health system. The real and marked shortage of blood stocks, especially during the COVID-19 pandemic, has encouraged the URGENT search for therapeutic options for blood transfusions.

Article

Objectives:

  1. To change the current transfusion practice, through the application of scientifically safe and effective PROTOCOLS for the TREATMENT OF ANEMIA and MANAGEMENT OF BLEEDING without the use of allogeneic blood, based on the scientific evidence of modern medicine.

  2. To Help blood banks SAVE their main HEMOCOMPONENTS (red blood cells, plasma and platelets)
Empirically used for over two centuries (since the 1800s) to reduce hemorrhage-related deaths, blood transfusion showed exponential growth in the early 20th century, as a result of the trauma produced by the two world wars (SHANDER, ISBISTER, & GOMBOTZ , 2016). However, in recent years, scientific medical literature has associated allogeneic blood transfusion with worse clinical outcomes, including higher mortality and, consequently, has been increasingly questioned about its safety and efficacy (ISBISTER et al., 2011; SANTOS et al. al., 2013).“Very little is known about the benefits of blood transfusion. Randomized clinical trials comparing blood transfusion with placebo have never been performed both before and after the release of blood transfusion as a treatment” (CARSON, REYNOLDS, & KLEIN, 2008), that is, blood transfusion has never been subjected to clinical trials placebo-controlled trials to assess their effectiveness.
Another concern with this medical practice is that “the transfusion has never been submitted for safety and efficacy evaluation by the Food and Drug Administration (FDA)”, although this agency allows its use (KUMAR, 2009).

In addition to this question, there is still the cost factor. According to the Guide for the Use of Blood Components of the Ministry of Health of Brazil (2015), the use of blood and blood components is an expensive practice for the SUS, which needs and uses state-of-the-art technology and highly specialized human resources. Another worrying factor today is the shortage of blood in blood centers around the world. To try to solve these three serious problems related to the use of allogeneic blood (lack of safety/efficacy, high cost and shortage) we propose a continuing medical education by reading the site bloodless.com.br. The best blood transfusion is the one that is not given.         

We have gathered here the main scientific evidence of today to support decision making regarding the use of one or multiple clinical and/or surgical strategies as a therapeutic option to reduce or eliminate the indication of an allogeneic blood transfusion. With this we will have fewer patients being transfused and less amount of blood and its components administered to each patient.

Knowing and learning to use this modern, safe and effective therapeutic arsenal becomes possible, it becomes feasible to perform any major, complex, cardiac or non-cardiac surgery, without the use of blood transfusions. Furthermore, it may be the only option available to save lives.

Dr. Antonio Alceu dos Santos

CRM - SP 94077

About the Author

  • Cardiology specialist certified by the Brazilian Society of Cardiology and the Brazilian Medical Association.
  • Cardiologist at the Beneficência Portuguesa Hospital in São Paulo and Lavras (Brazil) with experience in pre and postoperative cardiac surgery, including heart transplantation.
  • Author of scientific research published in national and international medical journals.
  • More than 20 years experience in therapeutic options and alternative techniques to blood transfusions.

  • Award for the best scientific work in experimental research, II International Meeting of Cardiology and Cardiovascular Surgery, Belo Horizonte (MG), 1995.

  • Member of SABM (Society for the Advancement of Blood Management).
  • Biography in the book Who’s Who in the World 31st Edition, 2014, page 2112.
  • Top 100 Health Professionals – 2014 – Non-transfusional modern medicine – International Biographical Centre of Cambridge, England.
  • Program in Hematology and Oncology – Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
TREAT ANEMIA and CONTROL BLEEDING without the use of allogeneic blood can mean:
A SMALL STEP FOR THE DOCTOR, BUT A BIG ADVANCE FOR MEDICINE