The feasibility and physiological aspects of anesthesia and surgery without homologous blood transfusion
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The modern practice of medicine has an ever-increasing dependency on the blood bank industry. Indeed, on many occasions there is an unwarranted and inappropriate use of hemotherapy. The first recorded blood transfusion was given to Pope Innocent VIII in 1492 (Narengo-Rowe, 1982). three blood donors This treatment was unsuccessful, and the patient and all died as a result of the experiment. Since then physicians have been mesmerized by the "0mnipotent" powers of extraneous blood in reversing disease processes, regardless of the inherent complications or the logical indications for such blood transfusions. It has been estimated that 12 million units of blood are transfused yearly into patients in the United States. This blood comes primarily from volunteer sources, but paid donors must necessarily be used, in order to make up for shortages created by the ever increasing demand. In addition, the cost of whole blood has risen steadily to $100.00 per unit in some hospitals and frozen blood is double this price. On average 2.5 units of blood are used for each transfusion and retrospective data analyses of the need for individual blood transfusions have unifonnly demonstrated that at least half of all blood transfusions were unnecessary. The risks of using homologous blood include isosensitization- disseminated intravascular coagulopathy, febrile reactions, bacterial contamimation, thrombophlebitis, hepatitis, cytomegalic viruses infection, syphilis- herpes, malaria, trypanosomiasis, thrombocytopenia, and reduced factor-VIII mediated coagulopathy. Cardiac arrhythmias may occur as a result of vascular overload and hemosiderosis. Blood, mismatched as a result of technical errors has also sometimes contributed to catastrophies. The risk of hepatitis is 20-46% with paid donors and ranges from 10-15% when volunteers are used for the provision of donor blood. Since only one-third of the patients become clinically jaundiced, it is difficult to detennine the total incidence without performing liver enzymes tests and antigen screening studies in all cases. The exact number of deaths directly related to the transfusion of blood is also difficult to determine due to various factors (including the failure of many hospitals to report such occurrences). Of the deaths which have been attributed to blood transfusion, 60% '"ere related to mismatched blood and 30% resulted from serum hepatitis (Myhre, 1980).