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Step 4: Benefits and risks
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The risks and benefits of bloodless methods -- compared to traditional medicine -- have not been well studied. The main benefit of bloodless medicine is that it allows people to avoid potential blood reactions and contaminants, and to follow certain religious beliefs. It also helps address blood supply issues. However, it is possible that bloodless medicine may provide a variety of other benefits, including fewer transfusion-associated complications, such as lung injuries.

All of these possibilities are being studied, but the evidence is preliminary.

Keep in mind that ALL patients undergoing any type of surgery -- whether bloodless or conventional -- face certain risks. There may be additional risks specific to you and your personal medical condition and history. Your individual risk and benefit ratio should be reviewed specifically with your physicians as you consider the medical options available to you.

Bloodless medicine, however, has some unique considerations.

When blood is lost -- but not replaced

In taking a bloodless approach, your health care team will strive to limit the possibility of heavy bleeding (hemorrhage). However, no surgical techniques or bloodless strategies can completely prevent the possibility of all bleeding. If an unforeseen circumstance results in major bleeding, and you have declined the use of blood donor products, you could experience serious blood loss that may need to be replaced to prevent organ injury or death. It is important that this unfortunate outcome be discussed in advance, so that you may guarantee that your wishes are followed.

In the rare event that this occurs during elective surgery, the complications that you'll experience depend on the amount of blood lost, the speed with which the blood is lost, and your baseline level of health. Healthy adults can usually lose up to 20% of their normal blood volume without suffering permanent damage. If the blood loss occurs slowly over time, a loss greater than 20% of normal blood volume may be tolerated without permanent effects.

However, severe blood loss can cause life-threatening complications such as low blood pressure, changes in the acidity of your blood, and decreased oxygen supply, resulting in damage to vital organs.

Depending upon the specific type of therapy or procedures employed, there may be other increased risks. For example, using some hemostatic agents may have side effects; aprotinin is associated with allergic reactions, and aminocaproic acid may cause blood clots or a condition called disseminated intravascular coagulation.

Discuss your options

If you are considering bloodless surgery, make sure that you understand the basic risks that accompany the particular procedure you'll be undergoing, discuss your unique personal risk factors with your health care team, and ask for help weighing the risks and benefits of using bloodless techniques.


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Review Date: 6/28/2011
Reviewed By: Frank A. Greco, MD, PhD, Director, Biophysical Laboratory, The Lahey Clinic, Burlington, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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