Medical Alternatives to Blood Transfusion

A new study guide produced by the Faculty of Health and Social Care at the University of the West of England focuses on the range of treatment options available to medical staff as alternatives to blood transfusion.

Medical and other health care staff are frequently faced with patients who for cultural, religious or other reasons may choose not to have blood transfusion in cases where it would be the standard medical procedure. The new guide is aimed at trainee doctors as well as practicing medical staff, and outlines the other medical options available in these circumstances.

The guide entitled 'Medicine and Surgery without Blood Transfusion: Facilitating Patient Autonomy with a New Standard of Care' is a collaborative venture between the University of the West of England and the Hospital Liaison Committee, which carries out medical liaison on behalf of Jehovah's Witnesses.

Shekar Bheenuck, principal lecturer at the University of the West of England, who co-coordinated the development of the guide says, "There are well known cultural and religious objections to blood transfusions which can result in ethical dilemmas for medical staff. Recent years have also seen an increase in the number of screening procedures for blood and blood products as a result of concerns over CJD and HIV infections and this has driven up the overall cost of blood transfusions. There is a clear need to reduce the number of blood transfusions which are being carried out and fortunately there are a number of medical alternatives available. The aim of this guide is to make these options more widely known to medical and other health care professionals faced with difficult ethical decisions."

"At the end of the day patient care is paramount. When someone has expressly made their wishes known about blood transfusion medical staff will be better prepared if they are able to suggest alternatives for that patient."

The study guide details examples of procedures which can be used to conserve blood and examples of 'bloodless' medicine and surgery. Alternatives to standard blood transfusions are for example when the patients own blood is recovered and can be stored and reinfused when needed (known as autologous procedures). Another option is for a patient's own blood to be recovered during or after surgery, for it to be cleaned and reinfused as appropriate.

Pul Bradley, Professor and Director of Clinical Skills at the Peninsula Medical School says, "This is a useful guide which we will use with some of our medical students. Both the ethical issues and the information on medical procedures contained in the guide will help medical staff to be better equipped to address these difficult medical decisions and dilemmas. We are also concerned nowadays to empower patients to be more directly involved in decisions about their medical care and this will help in that process."

David Smith of the Hospital Liaison Committee who collaborated on the guide said, "We welcome this initiative and hope that it is made widely available to medical staff. There is a clear need for a guide like this which will help medical staff become more aware of blood conservation techniques and transfusion alternatives where difficult decisions regarding blood transfusion need to be made."

The manual also carries a number of case studies for discussion in which difficult ethical and medical issues are highlighted, such as religious objections to blood transfusion.