Blood Transfusion, Oxygen, and Nitric Oxide

 

As if offering a pinch of incense to the gods, the article begins: "Blood transfusions have saved millions of lives." But doesn't the very next phrase almost douse the flame?

"yet stored red cells may be less effective than hoped for because they can quickly lose much of their ability to deliver oxygen."

They can? They do? If so, blood transfusions haven't saved as many lives as they are credited with, perhaps not any more than simple saline solution or any other fluid that aims only to replace lost volume. Jehovah's Witnesses have no objection to the latter. They do, however, for religious reasons, decline the former. They are well known for refusing blood transfusions.

If I had a nickel for every news article or web post lambasting us for our transfusion stand....some going so far as to call it tantamount to murder....I could buy myself a Maserati. And another, even fancier car for my wife, Mrs. Sheepandgoats. Blood substitutes are no good, they scream at us, because only the real thing, only real packed red cells, delivers the life-saving oxygen to the body. Yet according to this article, they don't!

The problem is that transfused blood needs nitric oxide to keep the blood vessels open, otherwise, the carried oxygen never reaches the tissues. But nitric oxide begins to break down within three hours of storage, and donated blood is presently stored up to 42 days. To be sure, researchers think they can remedy the problem. But that does nothing to improve the effectiveness of blood transfusions already given, each one of which was hailed as "life-saving," yet few of them actually qualifying as such, at least not any more so than saline solution, which offers no danger of rejection. We all know that the body spots foreign tissue in an instant, and tries hard to get rid of it.

Oddly, there are two versions of this AP story by Randolph E Schmid. One leads with the butt-kissing "blood transfusions have saved millions of lives" and one doesn't. I suspect Mr. Schmid, who is a science writer, did not include it. But somewhere along the line, some pious editor unable to tolerate the blood transfusion idol besmirched, added the phrase. Versions that have the phrase are here, here, and here. Versions that do not are here, here, and here. (I've included so many because some sources don't archive their stories very long....I hope some of them survive.)

All this reminds me of Bruce Spiess, addressing the Australian and New Zealand College of Anesthetists a few months ago. He declares blood transfusions have hurt more people than they've helped. Transfusions, he observes, are "almost a religion" because physicians practice them without solid evidence that they help. "Blood transfusion has evolved as a medical therapy and it's never been tested like a major drug," he said. "A drug is tested for safety and efficacy, blood transfusion has never been tested for either one."

Meanwhile, Jehovah's Witnesses steadfastly refuse blood transfusions (for religious reasons, not medical) and have created hundreds of Hospital Liaison Committees composed of members who interact with local hospitals and doctors. As a result, some in the medical field have pioneered bloodless techniques. By eliminating the risk of foreign tissue, human error, and blood-borne diseases, these new techniques offer a safety margin that conventional blood transfusions do not. The film Knocking states there are over 140 medical centers in North America that offer some form of bloodless surgical techniques. Might the day come, or is it even here already, when the number of lives saved through such medicine will outnumber those lost by a few members of a relatively tiny religious group that stuck to its principles amidst much opposition?

***********************  The bookstore

Comments

[Moshe Feldmann]

Jehovah's Witnesses refuse blood for religious reasons you say? Well I am Jewish and Jews see no religious conflict at all with blood transfusions. The command to not eat blood has nothing to do with blood transfusions. You see, all the blood transfusions in the world will not keep a starving man alive. Blood is food only if it is eaten, but transfused blood is only a medium to transport nutrients and oxygen- not food. The Bible says nothing about blood transfusions, but everything about the sacredness of life. JW's have been needlessly letting their loved ones die and as a result they must pay the price for both individual and Watchtower collective bloodguilt.

[Romulus Crowe]

Hi Tom

This was in new Scientist this week, along with the findings that sending oxygenated blood back into damaged tissue might make things worse, not better. Blood transfusions have saved lives, but they might also have ended a few prematurely. It's an accepted practice. It's accepted without question by doctors who say they can't accept homeopathy because it hasn't been studied in extreme detail. Go figure.

I'm fortunate never to have been in a position where I might need one so I can't say whether I'd accept or not. It's my understanding that the patient is rarely in a position to decide, often they're not even able to speak.

It's an organ transplant. It's therefore a matter for individual choice. If you'd rather be dead than have someone else's heart beating in you, why should anyone else argue with that?

If people say they don't like a particular group (in this case you -JW's) then why are they so adamant that you must be kept alive even when you don't want it?

Death holds no terrors for me. I've already seen them and they're not so bad. In an earlier post, you talked about the way our old people are kept alive as drooling vegetables using drugs, rather than being allowed a dignified exit. I'm with you on that one too. No adult diapers for me - I'd rather be worm-food than a profit margin for a drug company.

Only those who have no afterlife to look forward to are so filled with fear of death that they have to avoid it at any cost. My idea of what comes next differs from yours, but we can agree there IS a 'what comes next'.

There's another interesting article in that particular issue. It seems that if there was no ageing or disease, only accidental death or murder, the average lifespan of a human would be around 1400 years.

Even Adam only made it to 930. If he hadn't left Eden he might have had another 500 years in him.

[tom sheepandgoats]

Admittedly, this is a hot-button issue. Leviticus gives the reason behind the blood prohibition:

‘As for any man of the house of Israel or some alien resident who is residing as an alien in your midst who eats any sort of blood, I shall certainly set my face against the soul that is eating the blood, and I shall indeed cut him off from among his people. For the soul of the flesh is in the blood, and I myself have put it upon the altar for you to make atonement for your souls, because it is the blood that makes atonement by the soul [in it]. That is why I have said to the sons of Israel: “No soul of you must eat blood and no alien resident who is residing as an alien in your midst should eat blood.” Lev 17:10-12

Note that the reason has nothing to do with dietary or health considerations. The prohibition is extended in the New Testament, where Christians are told to "abstain" from blood. [Acts 15:20] "Abstaining" might be viewed as more than merely "eating," much as an alcoholic wouldn't really be abstaining from alcohol if he devised a method to inject it into his veins.

As mentioned in the post, doctors have developed bloodless medicine techniques, safer than transfusions, largely due to the tenacity (stubbornness?) of Jehovah's Witnesses. Made available to the general public, these methods should save considerable lives. Society will therefore owe a debt to JWs for medical advances, just as they now do in the field of constitutional law.

The pioneers take the arrows. It’s always been that way.

Moshe Feldman: If this study is correct, transfused blood carries little to no oxygen to cells, which is the only reason to choose it over safer non-blood volume expanders. Are you saying the study is incorrect?

Romulus: As Leviticus shows, our abstaining from blood is neither a desire for martyrdom, nor exercise of a right to die. We view it simply as being obedient to a command of God. Historically, people have been willing to put their lives on the line, if need be, for many causes, most far less noble than obeying God.

Do you have a link for that 1400 lifespan article? I'd love to read it.

[Aislinge]

I do know about the Jehovah's Witness edict against blood trasfusions, but I don't honestly know if there is or isn't a direct benefit to having one or not. In times of surgery they do have ways of working with those who cannot tolerate blood transfusions for whatever reason.

However, as someone who cannot give blood in the field (but often becomes an unwitting recipient of unasked-for blood), we all give praise to oxygen. The one medicine that EMT-Bs are allowed to give is O2 - and that saves far more lives.

I would stand by that statement any time.

Aislinge

[tom sheepandgoats]

Hmmm.

If blood subtitutes don't carry oxygen and transfused blood, for whatever reason, doesn't successfully make the transfer, can O2 administered through the airways compensate? I've never thought of (or heard of) that before. You know more than I.

I do know that the hematocrit value (% of red blood cells) that used to ring alarm bells and trigger efforts to give a blood transfusion was set completely arbitrarily. Much lower levels of oxygen in the bloodstream can be (temporarily) tolerated.

Thanks for your thoughts, Aislinge.

[Screech]

Interesting. It appears that the article is simply rewritten from the Associated Press article. Nice liberties taken. I like how the AP article comments how it is a necessary technology though it is detrimental in enough cases to concern medical professionals. I'm curious how they will restore the Nitrous Oxide at the time of transfusion. Will they suffuse it, like the air filters do for a fish tank?