Blood

The wound drain I mentioned yesterday was a Bellovac Drain although I am sure there are other drains out there that do the same thing. This drain is inserted whilst the patient is still on the operating table. The idea is to drain the haematoma from the wound site. This is effectively just pooled blood and it is in question weather or not draining this blood does much. This blood is no longer part of the circulating volume and this isnt supplying any tissue. Once the blood is drained into the bag a nurse can just replace the bag and hook the blood filled back up to a standard IV for transfusion. Obviously you require a certain amount of blood before its worth replacing the bag, anything less than 120ml and it will probably get lost in the IV tubing.

In my opinion this is one of the greatest recent achievements of medical science. I am still in awe of the fact we can reinfuse a patients own blood from a wound drain.

Sometime a patient wont bleed enough to warrent transfusion, this largely depends on the operation and the surgeon involved. Total Knee Replacements always bleed well. However for those who dislike transfusions there are other options for boosting your circulating volume. First off you hang a bag of saline just to keep the volume in the vessels high, and then you can administer a drug called erythropoietin. The athletes among you might refer to this as Epo. Its a drug designed to increase the rate at which the body produces red blood cells. This is of particular interest to athletes as the mood red blood cells you have circulating, the more haemoglobin, which means more oxygen, which means the muscles are better fed during periods of heavy exercise.

Suicide in the Name of God

Ok my first post is one that will likely ruffle a few feathers. Jehovahs Witnesses and elective surgical procedures. The following is not based on any patient I have known or ever heard of, the following is completely hypothetical and I accept no responsibility for any similarity between the following and any real patient.

A victim of a car crash or some other incident beyond their choosing is brought into A&E and requires a blood transfusion. This patient is a Jehovahs Witness, and as a result this patient refuses the vital transfusion in the name of their belief. I actually have no problem with this, infact on many levels I admire it, the level of faith required to choose death in this situation is incredible and certainly far beyond me.

My issue comes when a patient requires a total hip replacement, an entirely elective procedure which usually results in the need for a blood transfusion. This patient may be in pain but they have elected to undergo a surgery for a non-life threatening condition. The blood transfusion would be required to stabilise the patient after surgery as a certain amount of blood loss is expected. This patient is expecting the doctors, nurses, healthcare assistants and physiotherapists to work much harder. Unfortunately a consulting orthopaedic surgeon can not turn down this patient in pre-assessment based on their religion. This would be 'politically incorrect'.

What irritates me is there are certain wound drains available which drain the patients blood from the wound site during and after the operation and this blood can then be reinfused. It is the patients own blood so there is no risk of a transfusion reaction and In theory the blood has never left the circulation, it has just taken a detour. This is acceptable to some(few) Jehovahs Witnesses so I have no problem with such people. However an argument raised against it is that the blood has technically left the body.

Surely if they are willing to die to prove their beliefs they could take this one step further and live their lives in pain with decreased mobility.