BLOODLESS COUP FEARS OF INFECTION AND RELIGIOUS DICTATES SPUR PATIENTS TO SEEK TRANSFUSION-FREE SURGERY.

Byline: Theo Douglas Staff Writer

IN THE EARLY 1950s, Dr. Sterling Gainer Pillsbury documented in a medical journal how 50,000 babies were delivered at Long Beach's Seaside Hospital with no maternal deaths. The availability and use of blood transfusions, Pillsbury wrote, was in large part responsible.

Today, his son Dr. Sterling Gainer Pillsbury Jr., medical director at Long Beach Memorial Medical Center, presides over one of many hospitals offering procedures without the innovation his father praised.

An increasing number of Americans are requesting their hip replacements, open heart surgeries and spinal repairs be transfusion-free. Commonly referred to as ``bloodless medicine,'' this approach avoids transfusing patients with blood other than their own.

``It's becoming more and more a standard of care, particularly in the area of blood conservation,'' says Ron Williams, coordinator of the transfusion-free medicine department at Lakewood Regional Medical Center. ``There's a continuous chronic shortage of blood that's being reported in the news. And people are still concerned about sharing people's blood due to disease and things that can happen.''

Patients' reasons for choosing the bloodless option range from religious - Jehovah's Witnesses' faith precludes them from accepting foreign blood - to fear of transmitted diseases such as AIDS or hepatitis.

Encino-Tarzana Regional Medical Center has offered transfusion-free surgery since 1993. Jeff Jackman, program coordinator, predicts the procedure will become mainstream, particularly once one of several red blood cell substitutes in clinical trials is approved.

``Blood transfusion is going to be more risky,'' Jackman said. ``More and more things are being discovered that may be in the blood supply.''

Transfusion-free techniques got their start in the 1960s when specialists such as Texas cardiothoracic surgeon Denton Cooley adopted the discipline to minimize blood loss.

Healing as they cut

Doctors who perform ``bloodless'' operations do so through the use of surgical instruments which, in some cases, cauterize as they cut; medications that slow bleeding and promote clotting; cell saver or ``blood recycler'' machines; and operating techniques like minimal-access surgery.

``Most surgeries that are normally done with blood, we are able to focus on doing them without blood,'' says Lakewood's Williams, who cautions patients against thinking that major ``bloodless'' operations, such as heart, spinal and orthopedic surgery, can be done without any transfusion.

``That's the disclaimer. When we say 'transfusion-free,' the disclaimer is banked, stored blood,'' Williams says. ``They're constantly transfusing patients with other products (such as) saline solution. The key, when people think of transfusion-free, they think of avoiding someone else's blood.''

Estimates vary as to the pervasiveness of bloodless medicine, but most people in the medical field say the discipline is thriving.

``At one time, I had almost a monopoly on such patients. But now a lot of physicians are taking them on,'' says Texas surgeon Cooley. ``It's been a gradual thing since the early '70s. Now I think you could get a procedure at any major medical center in the country.''

Transfusion-free surgery is not without its hurdles. Medications, for example, may arouse allergies in patients and can prove toxic. Patients are carefully interviewed by medical staff as to their histories before operations.

And after operations, some patients may suffer from anemia - a condition where the blood is short on the red blood cells that bring it oxygen - and feel tired and weak. A veteran of ``bloodless'' surgery, Cooley admits, ``Some of my patients leave the hospital with anemia. Some people jokingly call it Cooley's anemia.''

Rest and medications can correct the problem. In fact, pharmaceuticals such as Epogen and Arithropoetin are specifically designed to stimulate the body's bone marrow to make more red blood cells.

Without a net

Because of the risks involved in surgery without a standby of blood, some physicians decline to perform transfusion-free surgeries. Even industry pioneer Cooley says, ``It's sort of like doing acrobatics without a net. You're just a little more careful because there's no net to catch you.''

One of the Lakewood Regional's recent patients was 71-year-old Claudia Gillian of Compton. A 25-year Jehovah's Witness, Gillian, a cancer patient, was referred to the hospital because her doctor declined to perform her hip replacement surgery transfusion-free. The reason, she says, was her medical history; she had had her hip broken during a previous operation to treat cancer in her leg.

``They said the operation was too serious and they didn't want to take the chance. So I got busy trying to find another doctor,'' says Gillian, who is recuperating at home from her operation and getting ready to resume cancer treatment. ``The doctor said I didn't lose hardly any blood. It was better than if I had had transfusions done.''

At USC's University Hospital, where the procedure has been available for five years, patients who opt for transfusion-free surgery sign a release that states they will not accept blood under any circumstances. USC is looking to develop protocol for patients who would prefer the bloodless option, but would want a transfusion in life-threatening circumstances. The question is how to define a life-threatening situation, said Randy Henderson, manager of USC's transfusion-free program.

Over the past three years, patients have shown increased interest in the procedure. The number of patients inquiring about transfusion-free surgery has jumped from about 10 percent to about 30 percent in that time span, Henderson said.

``I do think it will become the standard of care,'' he said. ``We're heading in that direction.''

The next step for widespread acceptance in the medical community is to provide data. USC is working on that now in conjunction with its living donor liver transplant program.

``That's the call from doctors who are skeptical,'' Henderson said. ``Is it safe and is it better? Besides anecdotal evidence, can you show us actual outcomes?''

Staff Writer Mariko Thompson contributed to this story.

How is it done?

Transfusion-free medicine is a multidisciplinary approach that avoids the use of foreign blood. The procedures involve some of the following components:

-- Medications like Amicar, which is used to inhibit bleeding, especially during heart surgery; Aprotinin, which reduces the need for transfusions during heart bypass surgery; Arithropoetin, a naturally occurring hormone that stimulates production of hemoglobin, and its synthetic copy, Epogen.

-- The cell saver machine, illustrated in graphic, which can be used during surgery to hold a portion of the patient's blood in reserve.

-- Lasers and microwave or ultrasonic scalpels that promote coagulation of tissues during incisions - and minimize tissue damage.

-- Minimal access surgery - surgery performed through small incisions in the body, using specially designed instruments and miniaturized telescope-like cameras that allow the surgeon to see his or her work on a television monitor instead of viewing it directly.

- T.D.

CAPTION(S):

5 photos, 2 boxes

Photo:

(1 -- cover -- color) Just your type

New drugs and techniques are improving surgery for patients who reject blood transfusions.

Michael Owen Baker/Staff Photographer

(2) no caption (Bag of blood)

(3) Dr. Sterling Gainer Pillsbury Jr., medical director at Long Beach Memorial Medical Center, which offers ``bloodless medicine,'' stands next to a portrait of his father, a doctor who advocated transfusions.

(4) Medicines that boost production of red blood cells aid transfusion-free surgery.

(5) The cell saver machine holds a portion of a patient's blood in reserve during surgery.

Suzanne Mapes/Special to the Daily News

Box:

(1) How is it done? (see text)

(2) HOW BLOODLESS SURGERY WORKS

Warren Huskey/Staff Artist