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Will Medicine Change?

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Will Medicine Change?
Understandably, within the last 20 years, interest in Transfusion Alternatives developed.

However, is that transfusion alternatives safe? Is it as effective as Blood Transfusion Treatment? What about the cost of transfusion alternatives?

Blood has always been a precious liquid to human life. So many have lost their lives by the shedding of their blood during times of war. Hunted as well as slaughtered animals died by the shedding of their blood. The power of life was in the blood. If so, does that mean that the sick can recover energy by drinking blood? People have really thought in such a way. To cure disease, people have even endured vomiting while gulping down animal’s fresh blood voraciously. They even drank human blood. This trend was not only among savage cannibals, but also among the civilized Romans who would run to a gladiator just fallen from a sword, and quaff with great thirst his flowing blood. Even in modern times, some people for the same reasons drink roe deer and deer blood.

In the winter of 1667, a violent madman was brought to Jean Denis, eminent physician to King Louis XIV of France. Denis had the ideal “cure” for mania—a transfusion of calf’s blood! But things did not go well. Finally 3 years later the procedure with the transfusion of animal blood was banned throughout France. In time, the English Parliament and even the pope followed suit. Blood transfusions fell into obscurity for the next 150 years.

In the 19th century, an English obstetrician led the revival of blood transfusion. With his insistence that only human blood should be used, he brought blood transfusions back into the limelight. But soon later a Polish doctor made a frightening discovery: More than half the transfusions performed had ended in death. The popularity of transfusions once again waned.

Then, in 1878, French physician Georges Hayem perfected a saline solution, which he claimed could serve as a substitute for blood. Unlike blood, the saline solution had no side effects, did not clot, and was easy to transport. Understandably, Hayem’s saline solution came to be widely used. In fact, nowadays, the most readily used common supplement (of blood volume) is “normal (0.9%) saline.”

On the other hand, surgeons who took care of injured soldiers at the war realized that loss of blood was one of the main causes of fatalities. Surgery was needed for severely bleeding soldiers (blood transfusion was yet to be introduced). There, so-called non-blood treatment and blood management techniques were formed. William S. Halsted, a surgeon on the battlefield in those early days, described “uncontrolled hemorrhage.” Afterwards he taught his trainees at Johns Hopkins the famous ‘Halstedian principles,’ that is, the technique of gentle tissue handling, surgery in anatomic ways, and meticulous hemostasis. His excellent work provides the basis of the surgical contribution to a blood management program.

In 1900, Austrian pathologist Landsteiner first discovered existence of blood types, and he found that one type of blood is not always compatible with another. No wonder so many transfusions in the past had ended in tragedy! Now that could be changed, simply by making sure that the blood type of the donor was compatible with that of the recipient. With this knowledge, physicians renewed their confidence in transfusions.

Coincidentally to that discovery, World War I broke out just in time. During World War I, blood was liberally transfused into wounded soldiers with fellow soldiers’ blood. However, blood withdrawn clotted quickly, and it was all but impossible to transport it to the battlefield from the posterior. Thus, people started to look for a substance that prevented the blood clotting. Finally an anticoagulant called ‘sodium citrate’ was developed in the U.S. (Presently, considerable amount of such anticoagulants are included in the blood transfer bags). This exciting breakthrough was no small miracle!

Shortly after, World War II broke out and saw an increase in the demand for blood. The public was bombarded with posters bearing such slogans as “Give Blood Now,” “He Gave His Blood. Will You Give Yours?”, and “If This Soldier Falls, Will Your Blood Be There To Save Him?” The call for blood brought great response. (The situation is similar today. For example, we heard the phrases such as, “Blood Drive: Blood Type A and Blood Type O Donors Urgently Needed!”, “Donate Blood. Donate Love.”, “Give Blood. Be a Hero!”, “Donate Blood and Save Lives!”)

From the experiences of two World Wars, great strides in medicine made possible some surgeries that were previously unimaginable, and blood transfusions were backing them up. Consequently, “blood banks” began popping up, and a global multibillion-dollar-a-year industry sprang up to supply the blood for transfusions, which physicians began to consider standard operating procedure.

However, soon some adverse reaction and diseases from blood transfusions became increasingly apparent. As mentioned earlier, during the Korean War the widely used plasma transfusion caused hepatitis to severely spread among soldiers. Thus, the US Army commissioned the use of “dextran” (a substance made from sugar), instead of blood plasma, from 1953 onward! Efforts to develop another “blood substitute were further intensified by US military in 1985. Major investments supported research, either by contract laboratories or by military facilities themselves. This time the purpose was to search for an oxygen carrier, but more was to be accomplished. The surgeon Gerald Klebanoff, who served in the Vietnam War, introduced a device for autotransfusion (the start of the blood salvage machine today), in military hospitals. Although officially declared to be a product for use in hemophiliacs, the Israeli army discovered that the recombinant clotting factor Villa had the potential to stop life-threatening hemorrhage and therefore included it in their treatment of injured victims.

From these historical facts, we have learned the following interesting points:

1) Originally non-blood treatment was a mainstream treatment. However more recently, about 70 years ago, blood transfusion became a mainstream treatment, but due to its side effects, non-blood medical care (transfusion alternatives) is emerging again.
2) The driving force of reemerging non-blood treatment that is alternative to the blood transfusion lies in experiences and skills of the small group of pioneering doctors. They made themselves available for needs of Jehovah’s Witnesses, who refuse blood transfusion due to religious reasons. Furthermore, the military authorities gave momentum to such development as they have made major investments in research in order to treat war injuries successfully.
3) The AIDS infection crisis in the 1980’s precipitated the public’s concern over blood ‘safety,’ and the governments’ efforts to respond, along with many reports on blood shortages, create an awareness that more concrete provisions alternative to blood transfusion are needed.

Like oil, blood – life’s precious liquid - is also a limited resource. It is only natural to see there is a shortage in blood supply.

Although donated blood has become safer with the implementation of additional safety measures, there is no guarantee that it is 100% safe. As it did with AIDS in the past, we can never be sure at present or in the future that another dreadful disease will surface with those infected with contaminated blood.

With current trends with the growing old age population and the need for surgery for them, as well as donors of blood is on the decline, and 20 % of donated blood proved to be inappropriate to use, the question is this: will conservative medicine change?

“Blood Inventory Depleted, Emergency Surgery Delayed, Donate Blood Now.” - This approach does not get to the root of the problem. The problem continues in a vicious circle. Blood conservation, and seeking medicine and surgery alternatives (rather than taking blood from another person with many anxieties) may be the answer.

Fortunately, those efforts are bearing fruit and better modalities are in use that achieve similar or better results for patients by using lesser amounts of others’ blood, or even no blood at all!