A step toward bloodless medicine and surgical practice will lead to rational use of blood: A literature review

Sir, Bloodless medicine and surgery (BMS) is the provision of quality health care to patients without the use of allogeneic blood with the aim of improving outcome and protecting patients' rights because it is evidencebased and associated with a better outcome.[1] BMS started as an attempt by some dedicated surgeons in the era of 1960s [Table 1] to accommodate patients who declined blood transfusion, notably the cult known as Jehovah's Witness.[2] Their religious belief is based on a distinctive interpretation of specific passages from the Bible, such as:Table 1: Bloodless surgeons and his achievements in Bloodless Medicine and Surgery practice“You are to abstain from … blood”– Acts Ch. 15 v. 29 (New English Bible)[3] The Canadian Critical Care Trial Group study on transfusion requirements in critical care was a landmark prospective, randomized study on 838 intensive care unit (ICU) patients comparing a liberal transfusion versus restricted transfusion policy. Interestingly, it revealed better results with the restricted transfusion group in terms of a lower ICU and hospital mortality, lower 30-day mortality, and a trend toward decreased organ failure.[4] Recently, there was a report in print media that in India every year 12 million units are required for transfusion, as against 10 million units collected by all the blood banks in the country, thereby leaving an annual deficit of 2 million units. On the other side, the absence of a robust blood-sharing network between the blood banks and hospitals has resulted in wastage of over 0.6 million liters of blood in the country in the last 5 years.[5] In recent years, the American Medical Association has listed transfusion as among the most overused therapies in medicine. Furthermore, “Medicine without Blood,” availed of Jehovah Witness has changed the way doctors think about blood transfusion.[6] The Government of Western Australia is the first to implement Patient Blood Management (PBM) as an official policy starting from 2008.[7] In 2010, the 63rd World Health Assembly of the World Health Organization offi cially recognized and adopted the “pillars” of PBM.[8] Doctors can use BMS techniques at three points throughout the surgical process [Table 2].Table 2: Principles of Bloodless Medicine and Surgery are outline belowBenefits of BMS practice include faster recovery and short hospital stay, experience fewer infections, avoid risk of posttransfusion reaction, lower morbidity and mortality, lower cost, and better patient satisfaction. Newer innovations in BMS comprise robotic surgery and pulse co-oximeter, thromboelastometry, plasmajet, and fibrin glue. In developing countries like India, if the hospital and health-care centers were to be provided with advance surgical and transfusion modalities, including instruments and skilled personals, then this goal can be achieved. BMS is not “a technique'” but a combination of techniques tailored to the needs and physiological status of the individual patient to avoid transfusion of allogeneic blood. BMS practice can be achieved by the coordination of blood providers and consumers. If surgeons apply scientifically sound practices to minimize blood loss and transfusion medicine specialists continually emphasis on BMS practice with the help of newer transfusion modalities, the goal can be comfortably achieved. If bloodless transfusion practice can be successfully done for the respect of religious beliefs, it also can be achieved for the humanitarian purpose. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgment I sincerely thank Dr. S R Joshi, Director of Lok Samarpan Raktadan Kendra and Research Center, Surat, for his inputs in preparing this article.

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