MAY 23, 2018
ROME—On Friday, November 24, 2017, medical, bioethics, and legal professionals convened at the University of Padua, one of the oldest universities in Italy, for the conference entitled “The Refusal of Blood Transfusion by Adult Patients: What Are the Treatment Options?—Blood Save 2017.” The conference was sponsored by more than 25 Italian scientific societies and associations as well as Italy’s Ministry of Health.
Traditionally, blood transfusions are considered harmless and the only life-saving medical treatment option for patients undergoing complex medical or surgical procedures. This assumption was challenged by many of the conference speakers. One of the visiting experts, Dr. Luca P. Weltert, a cardiothoracic surgeon at the European Hospital, Rome, explained: “We saw today that transfusions can be detrimental and in many cases are not needed.”
Dr. Weltert and other clinicians on the program reached this conclusion based on their clinical experience as well as evidence from scientific studies that establish a correlation between blood transfusions and increased mortality, morbidity, length of hospital stay, and other serious health risks for transfusion recipients. *
“We saw today that transfusions can be detrimental and in many cases are not needed.”—Dr. Luca Weltert, cardiothoracic surgeon, European Hospital, Rome
Such scientific evidence, along with the high cost of blood transfusions, moved the World Health Organization (WHO) in 2010 to identify the need for patient blood management (PBM)—a multidisciplinary and multimodal approach that focuses on health and patient safety, improves clinical outcomes, and significantly reduces the use of blood transfusions. The WHO issued a resolution that urged all 193 member states of the United Nations to implement PBM strategies.
Professor Stefania Vaglio, chief of transfusion medicine at the Sant’Andrea University Hospital, Rome, discussed at length the new culture of PBM, stating that formerly, medical care was dependent on handling and administering donor blood, but now “the focus has been completely switched from donor blood to a patient’s own blood.” One of the objectives of PBM is “to minimize blood loss by putting the patient at the center of the process, . . . focusing attention and doing all that is necessary in order to preserve the patient’s blood.” Professor Vaglio also clarified that medical techniques to conserve a patient’s own blood “actually mean better quality treatment.”
Dr. Tommaso Campagnaro, a general surgeon at the Verona University Hospital, confirmed the benefits of using strategies to avoid blood transfusions. After completing an analysis of data going back as far as the late 1990s involving patients undergoing the most complex abdominal surgical procedure, he concluded: “The patients who did not receive transfusions had less complications and a lower mortality rate compared to transfused patients.”
“The patients who did not receive transfusions had less complications and a lower mortality rate compared to transfused patients.”—Dr. Tommaso Campagnaro, general surgeon, Verona University Hospital
Dr. Campagnaro, along with several other conference speakers, publicly thanked Jehovah’s Witnesses for helping to prompt doctors to develop alternatives to blood transfusions. Anna Aprile, associate professor of medical law at the University of Padua, stated: “We thank Jehovah’s Witnesses, who have raised the issue of the right to refuse transfusions, helping everyone to reflect on this issue and to meet the challenge of using less blood.”
“We thank Jehovah’s Witnesses, who have raised the issue of the right to refuse transfusions . . .”—Anna Aprile, associate professor of medical law, University of Padua
The conference speakers represented diverse medical specialties, such as anesthesiology, cardiology, gynecology, hematology, oncology, and orthopedics. However, the overwhelming message was the same: the medical establishment, lawmakers, and the general public should all be open to PBM strategies in light of the growing body of published data and experiences from experts in the field.
Dr. Weltert adds: “Aortic dissection repair in contemporary surgical therapy represents the biggest surgery that you can do on a human body. . . . If [this] can be carried out without blood, then really anything can be done.”
^ par. 4 For example, a recent study conducted in Western Australia and published in one of the leading journals of transfusion medicine, Transfusion, was referenced during the conference. The authors of the study describe the results of a large-scale, six-year initiative to implement a comprehensive health-system-wide patient blood management program. They examined data from 605,046 patients admitted to four major adult tertiary-care hospitals. The use of blood products decreased by 41 percent during the study period. During the same period, there was also a 28 percent reduction in hospital mortality, a 15 percent reduction in the average hospital stay, a 21 percent reduction in hospital-acquired infections, and a 31 percent reduction of the incidence of heart attacks and strokes. Implementation of the PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.