Medical staff and the government are making efforts to minimize blood transfusion as there is a consensus that blood transfusion poses a threat to patients' safety. The development of medical technologies such as drugs and state-of-the-art equipment is the driving force behind blood-free surgery. Park Jung-Hoon, a professor of orthopedics at Korea University's Anam Hospital, said, "With the development of medical care, patients can be treated safely even if blood transfusion is minimized."
Blood transfusion is the easiest and most efficient way to supply insufficient blood. Nevertheless, the medical community is paying attention to blood-free surgery because there are two sides to a coin in blood transfusion.
The first is immune rejection. When immune cells in the body attack other people's blood as "enemies" like bacteria and viruses, minor side effects such as fever, urticaria, or fatal side effects such as acute lung injury can occur.
Secondly, there is a risk of infection. Although sterilization and testing techniques have been developed, it is difficult to protect patients' safety from bacteria, hepatitis B, and new viruses caused by blood transfusion.
Although it is rare to receive blood transfusions from other blood groups, accidents can still occur. According to data released by the Institute of Evaluation and Certification of Medical Institutions last year, a medical institution had an accident transferring blood type B to a patient with type O liver cancer. The medical staff confused the two blood stored in the same mass in a dedicated refrigerator. Although the blood transfusion was stopped immediately, it could have caused a serious situation due to immune rejection.
According to a paper published in the International Journal of Science and Technology (Lancet) in 2011, the number of patients transfused was 100 percent more dangerous than 40 percent and 30 percent, respectively.
Recently, insufficient blood volume has also emerged as a problem. It is a sense of crisis that excessive blood transfusions may not send enough blood to patients in need. Noh Jae-He, a professor of orthopedics at Suncheonhyang University Seoul Hospital, said, "In addition to the declining birthrate and aging population, the number of cases of delayed or canceled surgery due to lack of blood due to the pandemic."
According to the blood transfusion guidelines, healthy adults do not usually need blood transfusions unless the hemoglobin level in red blood cells is less than 7 g/ml or the blood that has been removed from the body is more than 30%. This is because the body changes for survival, such as maintaining the volume of fluid through the blood vessels and strengthening the oxygen-carrying capacity of red blood cells.
There are many ways to reduce blood transfusion. If you use iron or hematopoietic drugs to increase the amount and quality of blood before and after surgery, you can prepare for bleeding. "Cell Saver," which collects and re-doses blood that inevitably comes out during surgery, is also expanding its application to heart, artificial joints, and fracture surgery. The minimally invasive surgery using advanced equipment such as endoscopes, laparoscopes, and robots will lead to minimal incision, which means a reduction of bleeding and following minimization of blood transfusion. It also has the advantage of preserving surrounding tissues and allowing the patient's quick recovery. Of course, a blood transfusion is required for the same surgery depending on the patient's age, underlying disease, homochromatic levels, red blood cell volume, and heart rate. The same is true when people bleed too much in an accident or undergo major surgery such as cancer, heart, brain, and severe lung disease.
What matters is the interest of the medical staff and patients. Blood-free surgery is widely used in Australia and the United States. One reason is that blood prices are high in these countries. Compared to them, the blood transfusion rate in Korea is still high. According to a blood transfusion evaluation conducted by the Health Insurance Review and Evaluation Institute last year, the rate of transfusion of knee artificial joint surgery was 41 percent in Korea, far higher than that of the U.S. (8 percent), the U.K. (7.5 percent) and Australia (14 percent).
Writer: Yeyoung Jeon
(Picture from Unsplash)
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