ehovahs witnesses Patient Information Booklet blodless surgery by MelbinAntony1


									                                                                                                    Transfusion Alternatives for
                                                                                                    Jehovah’s Witnesses
                                                                                                    Patient Information Booklet

                                                         Designed and produced by Media Services.

            St George’s Healthcare NHS Trust
            St George’s Hospital
            Blackshaw Road
            Tel: 020 8672 1255
                                                         Job Ref: 9449


This information is for Jehovah’s Witness and it explains the   For further information and advice please contact:
alternatives to blood transfusions. There are two main
                                                                Mark Grumbridge
methods used as alternatives to transfusions. There are also
                                                                Transfusion Practitioner
drugs (medicines) that can be used to prevent / manage
                                                                St George’s Hospital
blood loss. This booklet tells you about each alternative
and explains the safety issues of each one.
                                                                Telephone 020 8725 0607 or call 020 8672 1255 bleep 7574

                                                                Kelly Feane
                                                                Transfusion Practitioner
                                                                St George’s Hospital

                                                                Telephone 020 8725 0607

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3. Erythropoietin                                                 Methods used as transfusion alternatives
Erythropoetin is a naturally occurring hormone produced by        1. Intra- operative cell salvage
the kidneys. It stimulates the body to produce more red
blood cells and is used to treat anaemia. It is widely used as    What is cell salvage?
a transfusion alternative. It is usually given by injection       Cell salvage is a method of
between one and three times per week. Side effects of             collecting blood loss during an
erythropoietin include:                                           operation and giving it back to
I high blood pressure                                             the patient. When cell salvage is
I skin reactions                                                  used, blood that is lost during
I headaches                                                       the operation is collected into
I bone pain                                                       a machine (see picture below).
I flu-like symptoms.                                              This filters and washes the blood
                                                                  to remove any contaminants. The
4. Aprotinin (Trasylol)                                           blood can then be given back to
Aprotinin is a drug that is given prior to heart surgery to       the patient during the operation
reduce the risk of bleeding and the need for transfusion.         or afterwards. The advantages of
Aprotinin is made from tissue taken from cows. There are          this are that the patient is given
side effects and risks in receiving Aprotinin                     a transfusion of their own blood.
I Thrombophlebitis (inflammation of the vein)
I Allergic reactions – very rare
                                                                  Is it acceptable for Jehovah’s Witnesses?
I Blood clot formation.
                                                                  This will depend on the views of the individual. Cell Salvage
As with all medicines there are risks associated with taking      is deemed acceptable by many Jehovah’s Witnesses as it does
or receiving such drugs. The side effects listed alongside each   not involve transfusion of blood from an unknown donor.
drug are those which have been reported by patients who
have received the medication and listed by the manufacturer       How safe is it?
as possible side effects. Patients can react differently to       It is a procedure that is now very common in modern
medicines and the risks and benefits of each of the listed        healthcare. There have not been any reports of any serious
medicines will be explained by your Consultant or a member        adverse incidents. The National Institute for Clinical
of his team.                                                      Excellence (NICE) has issued guidelines for its use in the UK
                                                                  and considers it a safe procedure.

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2. Acute Normovolaemic Haemodilution                             Drugs used to prevent / manage blood loss as
This method is sometimes called “bloodless” surgery. Before      transfusion alternatives
the operation a patient’s blood is collected into bags. A
                                                                 The following information covers a few examples of
“closed circuit” is then set up which involves maintaining the   common drugs used as transfusion alternatives. The use of
same amount of blood in the system with “volume                  such drugs depends on the type of surgery you will be
expanders” (a type of fluid). At the end of the operation,       having and also your current medical condition. Your
the blood is allowed to flow back to the patient. This is a      medical team will talk to you about the use of such
complex process and you might find the diagram below             medicines and other treatments.
                                                                 1. Tranexamic Acid (Cyklokapron)
                                                                 This medication is used to prevent heavy bleeding from
                                                                 dental extractions and nose bleeds in particular. It works by
                                                                 increasing clot formation and is useful in stopping severe
                                                                 blood loss during and after surgery. The drug can be given
                                                                 orally (by mouth) or intravenously (by injection). As with
                                                                 any medicine there are side effects. The main side effects of
                                                                 Tranexamic acid are:
                                                                 I nausea
                                                                 I vomiting
                                                                 I diarrhoea

                                                                 2. Novoseven
                                                                 Novoseven is a blood coagulation (Thickener) factor
                                                                 (ingredient). It works by making the blood clot at the site of
                                                                 bleeding when the body’s own clotting factors are not
                                                                 working. It can be used to treat severe bleeding episodes
                                                                 and to prevent excessive bleeding during surgery. It is usually
                                                                 given by injection. Again as with most drugs, Novoseven can
                                                                 have side effects. Common side effects include:
                                                                 I rash
                                                                 I fever
                                                                 I nausea

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