REPUBLICA DE VENEZUELA MINISTERIO DE EDUCACION SUPERIOR UNIVERIDAD PEDAGOGICA EXPERIMETAL EL LIBERTADOR INSTITUTO PEDAGOGICO RAFAEL ALVERTO ESCOBAR LARA

ESPECIALIDAD INGLS FORMACION ESPECIALIZADA LECTURA Y ESCRITURA II

NAME: Liz Liu Parra Campo CI. 19734568

BLOODLESS SURGERY THE WISE PATH AHA NEWS, published by the American Hospital Association, reported on why the bloodless surgeries are the most secure choice. The bloodless surgery has gained recognition. "What started as religious belief is evolving into medical preference and advanced technology," the weekly periodical observed. "Bloodless medicine and surgery, motivated in part by the doctrines of the Jehovah's Witnesses, is moving far beyond the needs of a spiritual society into operating rooms nationwide." In this essay we will analyze the reasons why the blood transfusions are completely unacceptable, (as such the religious principles involves, the risk to the contamination, the immunologic system) and the alternatives and benefits of a bloodless surgery. For bible based reasons, the Jehovah's Witnesses refuse blood transfusions. But they do acceptand vigorously pursuemedical alternatives to blood. "Jehovah's Witnesses actively seek the best in medical treatment," said Dr. Richard K. Spence, when was the director of surgery at a New York hospital. Actually, the Bible shows clearly that blood is more than a complex biologic fluid. It mentions blood over 400 times, and some of these references involve the saving of life. In one early reference, the Creator declared: "Everything that lives and moves will be food for you. . . . But you must not eat meat that has its lifeblood still in it." He added: "For your lifeblood I will surely demand an accounting," and he then condemned murder. (Genesis 9:3-6, New International Version). God then explained what a hunter was to do with a dead animal: "He shall pour out its blood and cover it with earth. . . .You shall not partake of the blood of any flesh, for the life of all flesh is its blood. Anyone who partakes of it shall be cut off."Leviticus 17:13, 14.

Scientists now know that the Jewish Law code promoted good health. It required, for example, that excrement be deposited outside the camp and covered and that people not eat meat that carried a high risk of disease. (Leviticus 11:4-8, 13; 17:15; Deuteronomy 23:12, 13) While the law about blood had health aspects, much more was involved; blood had a symbolic meaning; it stood for life provided by the Creator. By treating blood as special, the people showed dependence on him for life. Yes, the chief reason why they were not to take in blood was, not that it was unhealthy, but that it had special meaning to God. The Law repeatedly stated the Creator's ban on taking in blood to sustain life. "You must not eat the blood; pour it out on the ground like water. Do not eat it, so that it may go well with you and your children after you, because you will be doing what is right."Deuteronomy 12:23-25. Contrary to how some today reason, God's law on blood was not to be ignored just because an emergency arose. During a wartime crisis, some Israelite soldiers killed animals and "fell to eating along with the blood." In view of the emergency, was it permissible for them to sustain their lives with blood? No. Their commander pointed out that their course was still a grave wrong. (1 Samuel 14:31-35) Hence, precious as life is, our Life-Giver never said that his standards could be ignored in an emergency. Clearly a moral principle was involved. Human blood has great significance and should not be misused. Blood-borne disease worries conscientious physicians and many patients. Which disease? Frankly, you cannot limit it just to one; there are indeed many. After discussing the more well-known diseases, Techniques of Blood Transfusion (1982) addresses "other transfusionassociated infectious diseases," such as syphilis, cytomegalovirus infection, and malaria. It then says: "Several other diseases have also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis, leishmaniasis, brucellosis, typhus, filariasis, measles, salmonellosis, and Colorado tick fever." he AIDS virus was designated HIV, but some experts now call it HIV-1. Why? Because they found another virus of the AIDS type (HIV-2). It can cause AIDS symptoms and is widespread in some areas. Moreover, it "is not consistently detected by the AIDS tests now in use here," reports The New York Times. (June 27, 1989) "The new findings . . . make it more difficult for blood banks to be sure a donation is safe. A presidential commission (U.S.A.) said that one such virus "is believed to be the cause of adult T-cell leukemia/lymphoma and a severe neurological disease." This virus is already in the blood donor population and can be spread in blood. People have a right to wonder, 'How effective is the blood-bank screening for such other viruses?' "While blood transfusions are safer today than in the past, they still pose risks, including immune reactions and contracting hepatitis or sexually transmitted diseases." Dr. Terrence J. Sacchi, clinical assistant professor of medicine. Early in the 20th century, scientists deepened man's understanding of the marvelous complexity of blood. They learned that there are different blood types. Matching a donor's blood and a patient's blood is critical in transfusions. If someone with type A blood receives type B, he may have a severe hemolytic reaction. This can destroy many of his red cells and quickly kill him. While blood-typing and cross matching are now routine, errors do occur. Every year people die of hemolytic reactions. The facts show that the issue of incompatibility goes far beyond the relatively few blood types that hospitals seek to match.

Why? Well, in his article "Blood Transfusion: Uses, Abuses, and Hazards," Dr. Douglas H. Posey, Jr., writes: "Nearly 30 years ago Sampson described blood transfusion as a relatively dangerous procedure, [Since then] at least 400 additional red cell antigens have been identified and characterized. There is no doubt the number will continue to increase because the red cell membrane is enormously complex."Journal of the National Medical Association, July 1989. Scientists are now studying the effect of transfused blood on the body's defense, or immune, system. Even blood that has been "properly" cross matched can suppress the immune system. At a conference of pathologists, the point was made that hundreds of medical papers "have linked blood transfusions to immunologic responses." "Case Builds Against Transfusions," Medical World News, December 11, 1989. So it is understandable that some studies show that patients receiving blood are more prone to infection. Dr. P. I. Tartter did a study of colorectal surgery. Of patients given transfusions, 25 percent developed infections, compared with 4 percent of those who received no transfusions. He reports: "Blood transfusions were associated with infectious complications when given pre-, intra-, or postoperatively . . . The risk of postoperative infection increased progressively with the number of units of blood given." (The British Journal of Surgery, August 1988) Thankfully, there is an alternativebloodless medicine and surgery and many patients view it not as a last resort but as a preferred treatment, and with good reason. Stephen Geoffrey Pollard, a British consultant surgeon, notes that the morbidity and mortality rates among those who receive bloodless surgery are "at least as good as those patients who receive blood, and in many cases they are spared the postoperative infections and complications often attributable to blood. Doctors have now successfully applied bloodless techniques during operations and emergency procedures that traditionally required transfusions. "Major cardiac, vascular, gynaecological and obstetrical, orthopaedic, and urological surgery can be performed successfully without using blood or blood products," notes D.H.W. Wong, in the Canadian Journal of Anesthesia. One advantage of bloodless surgery is that it promotes better-quality care. "The surgeon's skill is of the greatest importance in the prevention of blood loss," says Dr. Benjamin J. Reichstein, a director of surgery in Cleveland, Ohio. A South African legal journal says that in certain instances surgery without blood can be "quicker, cleaner and less expensive." It adds: "Certainly the aftercare treatment in many instances has proved cheaper and less timeconsuming." These are just some of the reasons why there are currently more than 180 hospitals around the world that have programs specializing in bloodless medicine and surgery. The tragedy of AIDS has compelled scientists and physicians to take additional steps to make the operating room a safer place. Obviously, this has meant more stringent blood screening. But experts say that even these measures do not ensure zero-risk transfusions. If we imagine the worse situation, the case were someone has loses a lot of blood or has a terrible hemorrhages, it might seem logical just to replace it, but what is primarily needed is that the bleeding is stopped and the volume in his system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation.

Volume replacement can be accomplished without using whole blood or blood plasma. Various non-blood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as Dextran, Haemaccel, and lactated Ringer's solution. Hetastarch (HES) is a newer volume expander, and "it can be safely recommended for those [burn] patients who object to blood products." (Journal of Burn Care & Rehabilitation, January/February 1989. By other hand, salvaging machines recover blood that is lost during surgery or trauma. The blood is cleansed and can be returned to the patient in a closed circuit. In extreme cases, liters of blood can be recovered using such a system. Collagen and cellulose woven pads are another methods used to stop bleeding by direct application. Fibrin glues and sealants can plug puncture wounds or cover large areas of bleeding tissue. Thorough operative planning, including consultation with experienced clinicians, helps the surgical team to avoid complications. Prompt action to stop bleeding is essential. Delays greater than 24 hours can greatly increase patient mortality. Patients are protected from many hazards if they request non-blood medical management. Skilled physicians who have accepted the challenge of applying this on Jehovah's Witnesses have developed a standard of practice that is safe and effective, as is proved in numerous medical reports. Physicians who provide quality care without blood are not compromising valued medical principles. Rather, they show respect for a patient's right to know risks and benefits so that he can make an informed choice as to what will be done to his body and life. We are not being naive in this matter, for we realize that not all will agree with this approach. People differ as to conscience, ethics, and medical outlook. Hence, others, including some doctors, may find it hard to accept a patient's decision to abstain from blood. Most people who for religious and/or medical reasons, refuse blood but accept alternative medical therapy do very well. They may thus extend their life for years.

REPUBLICA DE VENEZUELA MINISTERIO DE EDUCACION SUPERIOR UNIVERIDAD PEDAGOGICA EXPERIMETAL EL LIBERTADOR INSTITUTO PEDAGOGICO RAFAEL ALVERTO ESCOBAR LARA ESPECIALIDAD INGLS FORMACION ESPECIALIZADA LECTURA Y ESCRITURA II

NAME: Liz Liu Parra Campo CI. 19734568

Outline BLOODLESS SURGERY THE WISEST CHOICE Introduction Thesis statement In this essay we will analyze the reasons why the blood transfusions should be unacceptable, as such the religious principles involves, the risk to the contamination, the immunologys suppression system danger, the alternatives and benefits of a bloodless surgery and at the and how even in the worse situation the bloodless procedure is safer than a blood transfusion. Body 1st Body Paragraph Yes, the chief reason why they were not to take in blood was, not that it was unhealthy, but that it had special meaning to God. 2nd Body Paragraph Secondly, theres the contamination risk, blood-borne disease worries conscientious physicians and many patients. 3rd Body Paragraph Even blood that has been "properly" cross matched can suppress the immune system. 4th Body Paragraph Thankfully, there is an alternativebloodless medicine and surgery and many patients view it not as a last resort but as a preferred treatment, and with good reason. 5th Body Paragraph If we imagine the worse situation, the case were someone has loses a lot of blood or has a terrible hemorrhages, it might seem logical just to replace it, but what is primarily needed is that the bleeding is stopped and the volume in his system be restored.

BLOODLESS THE WISEST CHOICE

IN 1996 the Royal College of Surgeons of England published a booklet called the Code of Practice for the Surgical Management of Jehovah's Witnesses. In that booklet the surgeons note: "The dangers of blood transfusion make it desirable to consider alternative measures whenever possible." Since the AHA NEWS, published by the American Hospital Association, reported on why the bloodless surgeries are the most secure choice. The bloodless surgery has gained recognition. "What started as religious belief is evolving into medical preference and advanced technology," the weekly periodical observed. "Bloodless medicine and surgery, motivated in part by the doctrines of the Jehovah's Witnesses, is moving far beyond the needs of a spiritual society into operating rooms nationwide." In this essay we will analyze the reasons why the blood transfusions should be unacceptable, as such the religious principles involves, the risk to the contamination, the immunologys suppression system danger, the alternatives and benefits of a bloodless surgery and at the and how even in the worse situation the bloodless procedure is safer than a blood transfusion. For the religious principles involves, lets analyzing the Jehovah's Witnesses refuse blood transfusions. Yes, the chief reason why they were not to take in blood was, not that it was unhealthy, but that it had special meaning to God. But they do acceptand vigorously pursuemedical alternatives to blood. "Jehovah's Witnesses actively seek the best in medical treatment," said Dr. Richard K. Spence, when director of surgery at a New York hospital. Actually, the Bible shows clearly that blood is more than a complex biologic fluid. It mentions blood over 400 times, and some of these references involve the saving of life. In one early reference, the Creator declared: "Everything that lives and moves will be food for you. . . . But you must not eat meat that has its lifeblood still in it." He added: "For your lifeblood I will surely demand an accounting," and he then condemned murder. (Genesis 9:3-6, New International Version). God then explained what a hunter was to do with a dead animal: "He shall pour out its blood and cover it with earth. . . .You shall not partake of the blood of any flesh, for the life of all flesh is its blood. Anyone who partakes of it shall be cut off."Leviticus 17:13, 14. Scientists now know that the Jewish Law code promoted good health. It required, for example, that excrement be deposited outside the camp and covered and that people not eat meat that carried a high risk of disease. (Leviticus 11:48, 13; 17:15; Deuteronomy 23:12, 13) While the law about blood had health aspects, much more was involved; blood had a symbolic meaning, it stood for life provided by the Creator. By treating blood as special, the people showed dependence on him for life. The Law repeatedly stated the Creator's ban on taking in blood to sustain life. "You must not eat the blood; pour it out on the ground like water. Do not eat it, so that it may go well with you and your children after you, because you will be doing what is right."Deuteronomy 12:23-25. Contrary to how some today reason, God's law on blood was not to be ignored just because an emergency arose. During a wartime crisis, some Israelite soldiers killed animals and "fell to eating along with the blood." In view of the emergency, was it permissible for them to sustain their lives with blood? No. Their commander pointed out that their course was still a grave wrong. (1 Samuel 14:31-35) Hence, precious as life is,

our Life-Giver never said that his standards could be ignored in an emergency. Clearly a moral principle was involved. Human blood has great significance and should not be misused. Secondly, theres the contamination risk, blood-borne disease worries conscientious physicians and many patients. Which disease? Frankly, you cannot limit it just to one; there are indeed many. After discussing the more well-known diseases, Techniques of Blood Transfusion (1982) addresses "other transfusion-associated infectious diseases," such as syphilis, cytomegalovirus infection, and malaria. It then says: "Several other diseases have also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis, leishmaniasis, brucellosis, typhus, filariasis, measles, salmonellosis, and Colorado tick fever." he AIDS virus was designated HIV, but some experts now call it HIV-1. Why? Because they found another virus of the AIDS type (HIV-2). It can cause AIDS symptoms and is widespread in some areas. Moreover, it "is not consistently detected by the AIDS tests now in use here," reports The New York Times. (June 27, 1989) "The new findings . . . make it more difficult for blood banks to be sure a donation is safe. A presidential commission (U.S.A.) said that one such virus "is believed to be the cause of adult T-cell leukemia/lymphoma and a severe neurological disease." This virus is already in the blood donor population and can be spread in blood. People have a right to wonder, 'How effective is the blood-bank screening for such other viruses?' "While blood transfusions are safer today than in the past, they still pose risks, including immune reactions and contracting hepatitis or sexually transmitted diseases."Dr. Terrence J. Sacchi, clinical assistant professor of medicine. The tragedy of AIDS has compelled scientists and physicians to take additional steps to make the operating room a safer place. Obviously, this has meant more stringent blood screening. But experts say that even these measures do not ensure zero-risk transfusions. Early in the 20th century, scientists deepened man's understanding of the marvelous complexity of blood. They learned that there are different blood types. Even blood that has been "properly" cross matched can suppress the immune system. Matching a donor's blood and a patient's blood is critical in transfusions. If someone with type A blood receives type B, he may have a severe hemolytic reaction. This can destroy many of his red cells and quickly kill him. While blood-typing and cross matching are now routine, errors do occur. Every year people die of hemolytic reactions. The facts show that the issue of incompatibility goes far beyond the relatively few blood types that hospitals seek to match. Why? Well, in his article "Blood Transfusion: Uses, Abuses, and Hazards," Dr. Douglas H. Posey, Jr., writes: "Nearly 30 years ago Sampson described blood transfusion as a relatively dangerous procedure, [Since then] at least 400 additional red cell antigens have been identified and characterized. There is no doubt the number will continue to increase because the red cell membrane is enormously complex."Journal of the National Medical Association, July 1989. Scientists are now studying the effect of transfused blood on the body's defense, or immune, system. At a conference of pathologists, the point was made that hundreds of medical papers "have linked blood transfusions to immunologic

responses.""Case Builds Against Transfusions," Medical World News, December 11, 1989. So it is understandable that some studies show that patients receiving blood are more prone to infection. Dr. P. I. Tartter did a study of colorectal surgery. Of patients given transfusions, 25 percent developed infections, compared with 4 percent of those who received no transfusions. He reports: "Blood transfusions were associated with infectious complications when given pre-, intra-, or postoperatively . . . The risk of postoperative infection increased progressively with the number of units of blood given." (The British Journal of Surgery, August 1988) Thankfully, there is an alternativebloodless medicine and surgery and many patients view it not as a last resort but as a preferred treatment, and with good reason. Stephen Geoffrey Pollard, a British consultant surgeon, notes that the morbidity and mortality rates among those who receive bloodless surgery are "at least as good as those patients who receive blood, and in many cases they are spared the postoperative infections and complications often attributable to blood. Doctors have now successfully applied bloodless techniques during operations and emergency procedures that traditionally required transfusions. "Major cardiac, vascular, gynaecological and obstetrical, orthopaedic, and urological surgery can be performed successfully without using blood or blood products," notes D.H.W. Wong, in the Canadian Journal of Anesthesia. There several alternative methods like, Fluids, ringer's lactate solution, dextran, hydroxyethyl starch, and others are used to maintain blood volume, preventing hypovolemic shock. Some fluids now being tested can transport oxygen. Drugs, genetically engineered proteins can stimulate the production of red blood cells (erythropoietin), blood platelets (interleukin-11), and various white blood cells (GM-CSF, G-CSF). Other medications greatly reduce blood loss during surgery (aprotinin, antifibrinolytics) or help to reduce acute bleeding (desmopressin). Biological hemostats, collagen and cellulose woven pads are used to stop bleeding by direct application. Fibrin glues and sealants can plug puncture wounds or cover large areas of bleeding tissue. Blood salvage, salvaging machines recover blood that is lost during surgery or trauma. The blood is cleansed and can be returned to the patient in a closed circuit. In extreme cases, liters of blood can be recovered using such a system. Surgical techniques, thorough operative planning, including consultation with experienced clinicians, helps the surgical team to avoid complications. Prompt action to stop bleeding is essential. Delays greater than 24 hours can greatly increase patient mortality. Dividing large surgeries into several smaller ones decreases total blood loss. Surgical tools, Some devices cut and seal blood vessels simultaneously. Other devices can seal bleeding on large areas of tissue. Laparoscopic and minimally invasive instruments allow surgeries to be performed without the blood loss associated with large incisions. One advantage of bloodless surgery is that it promotes better-quality care. "The surgeon's skill is of the greatest importance in the prevention of blood loss," says Dr. Benjamin J. Reichstein, a director of surgery in Cleveland, Ohio. A South African legal journal says that in certain instances surgery without blood can be "quicker, cleaner and less expensive." It adds: "Certainly the aftercare treatment in many instances has proved cheaper and less time-consuming." These are just some of the reasons why there are currently more than 180 hospitals around the world that have programs specializing in bloodless medicine and surgery.

If we imagine the worse situation, the case were someone has loses a lot of blood or has a terrible hemorrhages, it might seem logical just to replace it, but what is primarily needed is that the bleeding is stopped and the volume in his system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation. Volume replacement can be accomplished without using whole blood or blood plasma. Various non-blood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as Dextran, Haemaccel, and lactated Ringer's solution. Hetastarch (HES) is a newer volume expander, and "it can be safely recommended for those [burn] patients who object to blood products." (Journal of Burn Care & Rehabilitation, January/February 1989. By other hand, salvaging machines recover blood that is lost during surgery or trauma. The blood is cleansed and can be returned to the patient in a closed circuit. In extreme cases, liters of blood can be recovered using such a system. Collagen and cellulose woven pads are another methods used to stop bleeding by direct application. Fibrin glues and sealants can plug puncture wounds or cover large areas of bleeding tissue. Thorough operative planning, including consultation with experienced clinicians, helps the surgical team to avoid complications. Prompt action to stop bleeding is essential. Delays greater than 24 hours can greatly increase patient mortality. Skilled physicians who have accepted the challenge of applying this on Jehovah's Witnesses have developed a standard of practice that is safe and effective, as is proved in numerous medical reports. Physicians who provide quality care without blood are not compromising valued medical principles. Rather, they show respect for a patient's right to know risks and benefits so that he can make an informed choice as to what will be done to his body and life. We are not being naive in this matter, for we realize that not all will agree with this approach. People differ as to conscience, ethics, and medical outlook. Hence, others, including some doctors, may find it hard to accept a patient's decision to abstain from blood. Most people who for religious and/or medical reasons, refuse blood but accept alternative medical therapy do very well. They may thus extend their life for years.

Bibliography http://www.watchtower.org/e/20000108/article_01.htm http://www.watchtower.org/e/19980822/article_01.htm http://www.watchtower.org/e/200608/article_01.htm http://kidshealth.org/teen/your_body/medical_care/transfusions.html#

Blood TransfusionsHow Safe?

Before submitting to any serious medical procedure, a thinking person will learn the possible benefits and the risks. What about blood transfusions? They are now a prime tool in medicine. Many physicians who are genuinely interested in their patients may have little hesitation about giving blood. It has been called the gift of life. Millions have donated blood or have accepted it. For 1986-87 Canada had 1.3 million donors in a population of 25 million. "[In] the most recent year for which figures are available, between 12 million and 14 million units of blood were used in transfusions in the United States alone."The New York Times, February 18, 1990. "Blood has always enjoyed a 'magical' quality," notes Dr. Louise J. Keating. "For its first 46 years, the blood supply was perceived as being safer than it actually was by both physicians and the public." (Cleveland Clinic Journal of Medicine, May 1989) What was the situation then, and what is it now? Even 30 years ago, pathologists and blood-bank personnel were advised: "Blood is dynamite! It can do a great deal of good or a great deal of harm. The mortality from blood transfusion equals that from ether anesthesia or appendectomy. There is said to be approximately one death in 1,000 to 3,000 or possibly 5,000 transfusions. In the London area there has been reported one death for every 13,000 bottles of blood transfused."New York State Journal of Medicine, January 15, 1960. Have the dangers since been eliminated so that transfusions are now safe? Frankly, each year hundreds of thousands have adverse reactions to blood, and many die. In view of the preceding comments, what may come to your mind are blood-borne diseases. Before examining this aspect, consider some risks that are less wellknown. BLOOD AND YOUR IMMUNITY

Early in the 20th century, scientists deepened man's understanding of the marvelous complexity of blood. They learned that there are different blood types. Matching a donor's blood and a patient's blood is critical in transfusions. If someone with type A blood receives type B, he may have a severe hemolytic reaction. This can destroy many of his red cells and quickly kill him. While blood-typing and cross matching are now routine, errors do occur. Every year people die of hemolytic reactions. The facts show that the issue of incompatibility goes far beyond the relatively few blood types that hospitals seek to match. Why? Well, in his article "Blood Transfusion: Uses, Abuses, and Hazards," Dr. Douglas H. Posey, Jr., writes: "Nearly 30 years ago Sampson described blood transfusion as a relatively dangerous procedure . . .[Since then] at least 400 additional red cell antigens have been identified and characterized. There is no doubt the number will continue to increase because the red cell membrane is enormously complex."Journal of the National Medical Association, July 1989. Scientists are now studying the effect of transfused blood on the body's defense, or immune, system. What might that mean for you or for a relative who needs surgery?

"Approximately 1 in 100 transfusions are accompanied by fever, chills, or urticaria [hives]. . . . Approximately 1 in 6,000 red cell transfusions results in a hemolytic transfusion reaction. This is a severe immunologic reaction that may occur acutely or in a delayed fashion some days after the transfusion; it may result in acute [kidney] failure, shock, intravascular coagulation, and even death."National Institutes of Health (NIH) conference, 1988. When doctors transplant a heart, a liver, or another organ, the recipient's immune system may sense the foreign tissue and reject it. Yet, a transfusion is a tissue transplant. Even blood that has been "properly" cross matched can suppress the immune system. At a conference of pathologists, the point was made that hundreds of medical papers "have linked blood transfusions to immunologic responses.""Case Builds Against Transfusions," Medical World News, December 11, 1989. A prime task of your immune system is detecting and destroying malignant (cancer) cells. Could suppressed immunity lead to cancer and death? Note two reports. The journal Cancer (February 15, 1987) gave the results of a study done in the Netherlands: "In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the nontransfused patients." Physicians at the University of Southern California followed up on a hundred patients who underwent cancer surgery. "The recurrence rate for all cancers of the larynx was 14% for those who did not receive blood and 65% for those who did. For cancer of the oral cavity, pharynx, and nose or sinus, the recurrence rate was 31% without transfusions and 71% with transfusions."Annals of Otology, Rhinology & Laryngology, March 1989. What do such studies suggest regarding transfusions? In his article "Blood Transfusions and Surgery for Cancer," Dr. John S. Spratt concluded: "The cancer surgeon may need to become a bloodless surgeon."The American Journal of Surgery,September 1986.

Another primary task of your immune system is to defend against infection. So it is understandable that some studies show that patients receiving blood are more prone to infection. Dr. P. I. Tartter did a study of colorectal surgery. Of patients given transfusions, 25 percent developed infections, compared with 4 percent of those who received no transfusions. He reports: "Blood transfusions were associated with infectious complications when given pre-, intra-, or postoperatively . . . The risk of postoperative infection increased progressively with the number of units of blood given." (The British Journal of Surgery, August 1988) Those attending a 1989 meeting of the American Association of Blood Banks learned this: Whereas 23 percent of those who received donor blood during hip-replacement surgery developed infections, those given no blood had no infections at all. Dr. John A. Collins wrote concerning this effect of blood transfusions: "It would be ironic indeed if a 'treatment' which has very little evidence of accomplishing anything worthwhile should subsequently be found to intensify one of the main problems faced by such patients."World Journal of Surgery, February 1987. DISEASE FREE OR FRAUGHT WITH DANGER?

Danish scientist Niels Jerne shared the 1984 Nobel Prize for Medicine. When asked why he refused a blood transfusion, he said: "A person's blood is like his fingerprintsthere are no two types of blood that are exactly alike."

Blood-borne disease worries conscientious physicians and many patients. Which disease? Frankly, you cannot limit it just to one; there are indeed many. After discussing the more well-known diseases,Techniques of Blood Transfusion (1982) addresses "other transfusion-associated infectious diseases," such as syphilis, cytomegalovirus infection, and malaria. It then says: "Several other diseases have also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis [African sleeping sickness and Chagas' disease], leishmaniasis, brucellosis [undulant fever], typhus, filariasis, measles, salmonellosis, and Colorado tick fever."

BLOOD, RUINED LIVERS, AND . . . "Ironically, blood-borne AIDS . . . has never been as great a threat as other diseaseshepatitis, for instance," explained the Washington Post. Yes, vast numbers have got very sick and have died from such hepatitis, which has no specific treatment. According to U.S.News & World Report (May 1, 1989), about 5 percent of those given blood in the United States get hepatitis175,000 people a year. About half become chronic carriers, and at least 1 in 5 develop cirrhosis or cancer of the liver. It is estimated that 4,000 die. Imagine the headlines you would read if a jumbo jet crashed, killing all aboard. But 4,000 deaths amount to a full jumbo jet crashing every month! Physicians had long known that a milder hepatitis (type A) was spread through unclean food or water. Then they saw that a more serious form was spreading through blood, and they had no way to screen blood for it. Eventually, brilliant scientists learned how to detect "footprints" of this virus (type B). By the early 1970's, blood was being screened in some lands. The blood supply appeared safe and the future for blood bright! Or was it? Before long it was clear that thousands who were given screened blood still developed hepatitis. Many, after debilitating illness, learned that their livers were ruined. But if the blood had been tested, why was this happening? The blood contained another form, called non-A, non-B hepatitis (NANB). For a decade it plagued transfusionsbetween 8 and 17 percent of those transfused in Israel, Italy, Japan, Spain, Sweden, and the United States contracted it. Then came headlines such as "Mysterious Hepatitis Non-A, Non-B Virus Isolated at Last"; "Breaking a Fever in the Blood." Again, the message was, 'The elusive agent is found!' In April 1989, the public was told that a test was available for NANB, now being called hepatitis C. You might wonder if this relief is premature. In fact, Italian researchers have reported another hepatitis virus, a mutant, which might be responsible for a third of the cases. "Some authorities," the Harvard Medical School Health Letter (November 1989) observed, "worry that A, B, C, and D are not the whole alphabet of hepatitis viruses; yet others may emerge." The New York Times (February 13, 1990) stated: "Experts strongly suspect that other viruses can cause hepatitis; if discovered, they will be designated hepatitis E and so on." Are blood banks faced with more long searches for tests to make blood safe? Citing the problem of cost, a director of the American Red Cross made this disturbing comment: "We can't just keep adding test after test for each infectious agent that might be spread."Medical World News, May 8, 1989.

Even the test for hepatitis B is fallible; many still contract it from blood. Moreover, will people be satisfied with the announced test for hepatitis C? The Journal of the American Medical Association (January 5, 1990) showed that a year can pass before antibodies of the disease are detectable by the test. Meanwhile, people transfused with the blood may face ruined liversand death.

Actually, the list of such diseases is growing. You may have read headlines such as "Lyme Disease From a Transfusion? It's Unlikely, but Experts Are Wary." How safe is blood from someone testing positive for Lyme disease? A panel of health officials were asked if they would accept such blood. "All of them answered no, although no one recommended discarding blood from such donors." How should the public feel about banked blood that experts themselves would not accept?The New York Times, July 18, 1989. A second reason for concern is that blood collected in one land where a certain disease abounds may be used far away, where neither the public nor the physicians are alert to the danger. With today's increase in travel, including refugees and immigrants, the risk is growing that a strange disease may be in a blood product. Moreover, a specialist in infectious diseases warned: "The blood supply may have to be screened to prevent transmission of several disorders that were not previously considered infectious, including leukemia, lymphoma, and dementia [or Alzheimer's disease]."Transfusion Medicine Reviews, January 1989. Chilling as these risks are, others have created much wider fear. THE AIDS PANDEMIC

"AIDS has changed forever the way doctors and patients think about blood. And that's not a bad idea, said the doctors gathered at the National Institutes of Health for a conference on blood transfusion."Washington Post, July 5, 1988. The AIDS (acquired immunodeficiency syndrome) pandemic has, with a vengeance, awakened people to the danger of acquiring infectious diseases from blood. Millions are now infected. It is spreading out of control. And its death rate is virtually 100 percent. AIDS is caused by the human immunodeficiency virus (HIV), which can be spread by blood. The modern plague of AIDS came to light in 1981. The very next year, health experts learned that the virus could probably be passed on in blood products. It is now admitted that the blood industry was slow to respond, even after tests were available to identify blood containing HIV antibodies. Testing of donor blood finally began in 1985,* but even then it was not applied to blood products that were already on the shelf.

Chagas' disease illustrates how blood carries disease to distant people. The Medical Post (January 16, 1990) reports that '10-12 million people in Latin America are chronically infected.' It has been called "one of the most important transfusion hazards in South America." An "assassin bug" bites a sleeping victim in the face, sucks blood, and defecates in the wound. The victim may carry Chagas' disease for years (meanwhile possibly donating blood) before developing fatal heart complications. Why should that concern people on distant continents? In The New York Times (May

23, 1989), Dr. L. K. Altman reported on patients with posttransfusion Chagas' disease, one of whom died. Altman wrote: "Additional cases may have gone undetected because [doctors here] are not familiar with Chagas' disease, nor do they realize that it could be spread by transfusions." Yes, blood can be a vehicle by which diseases travel widely.

Thereafter the public was assured, 'The blood supply is now safe.' Later, however, it was revealed that there is a dangerous "window period" for AIDS. After a person is infected, it could be months before he produces detectable antibodies. Unaware that he harbors the virus, he might donate blood that would test negative. This has happened. People have developed AIDS after being transfused with such blood! AIDS virus The picture got even grimmer. The New England Journal of Medicine (June 1, 1989) reported on "Silent HIV Infections." It was established that people can carry the AIDS virus for years without its being detectable by current indirect tests. Some would like to minimize these as rare cases, but they prove "that the risk of AIDS transmission via blood and its components cannot be totally eliminated." (Patient Care, November 30, 1989) The disturbing conclusion: A negative test cannot be read as a clean bill of health. How many will yet get AIDS from blood? THE NEXT SHOE? OR SHOES?

Many apartment dwellers have heard the thump of one shoe hitting the floor above them; they may then get tense awaiting the second. In the blood dilemma, no one knows how many deadly shoes may still hit. The AIDS virus was designated HIV, but some experts now call it HIV-1. Why? Because they found another virus of the AIDS type (HIV-2). It can cause AIDS symptoms and is widespread in some areas. Moreover, it "is not consistently detected by the AIDS tests now in use here," reports The New York Times. (June 27, 1989) "The new findings . . . make it more difficult for blood banks to be sure a donation is safe." Or what of distant relatives to the AIDS virus? A presidential commission (U.S.A.) said that one such virus "is believed to be the cause of adult T-cell leukemia/lymphoma and a severe neurological disease." This virus is already in the blood donor population and can be spread in blood. People have a right to wonder, 'How effective is the blood-bank screening for such other viruses?' Really, only time will tell how many blood-borne viruses are lurking in the blood supply. "The unknown may be more cause for concern than the known," writes Dr. Harold T. Meryman. "Transmissible viruses with incubation times measured in many years will be difficult to associate with transfusions and even more difficult to detect. The HTLV group is surely only the first of these to surface." (Transfusion Medicine Reviews, July 1989) "As if the AIDS epidemic were not misery enough, . . . a number of newly proposed or described risks of transfusion have drawn attention during the 1980's. It does not require great imagination to predict that other serious viral diseases exist and are transmitted by homologous transfusions."Limiting Homologous Exposure: Alternative Strategies, 1989. So many "shoes" have already dropped that the Centers for Disease Control recommends "universal precautions." That is,

Dr. Knud Lund-Olesen wrote: "Since . . . some persons in high-risk groups volunteer as donors because they are then automatically tested for AIDS, I feel that there is reason to be reluctant about accepting blood transfusion. Jehovah's Witnesses have refused this for many years. Did they look into the future?"Ugeskrift for Lger (Doctors' Weekly), September 26, 1988.

'health-care workers should assume that all patients are infectious for HIV and other blood-borne pathogens.' With good reason, health-care workers and members of the public are reassessing their view of blood.

* We cannot assume that all blood is yet being tested. For example, it is reported that by the start of 1989, about 80 percent of Brazil's blood banks were not under government control, nor were they testing for AIDS.

Picture Credit: AIDS virus: CDC, Atlanta, Ga.

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U P EL - I PRAEL ESPECIALIDAD INGLS FORMACION ESPECIALIZADA LECTURA Y ESCRITURA II

Name: Liz Liu Parra Campo

BLOODLESS -THE BEST CHOICE

IN 1996 the Royal College of Surgeons of England published a booklet called the Code of Practice for the Surgical Management of Jehovah's Witnesses. In that booklet the surgeons note: "The dangers of blood transfusion make it desirable to consider alternative measures whenever possible."

Since the AHA NEWS, published by the American Hospital Association, reported on why the bloodless surgeries are the most secure choice. The bloodless surgery has gained recognition. "What started as religious belief is evolving into medical preference and advanced technology," the weekly periodical observed. "Bloodless medicine and surgery, motivated in part by the doctrines of the Jehovah's Witnesses, is moving far beyond the needs of a spiritual society into operating rooms nationwide." In this essay we will analyze the reasons why the blood transfusions should be unacceptable, as such the religious principles involves, the risk to the contamination, the immunologys suppression system danger, the alternatives and benefits of a bloodless surgery and at the and how even in the worse situation the bloodless procedure is safer than a blood transfusion. For the religious principles involves, lets analyzing the Jehovah's Witnesses refuse blood transfusions. Yes, the chief reason why they were not to take in blood was, not that it was unhealthy, but that it had special meaning to God. But they do acceptand vigorously

pursuemedical alternatives to blood. "Jehovah's Witnesses actively seek the best in medical treatment," said Dr. Richard K. Spence, when director of surgery at a New York hospital. Actually, the Bible shows clearly that blood is more than a complex biologic fluid. It mentions blood over 400 times, and some of these references involve the saving of life. In one early reference, the Creator declared: "Everything that lives and moves will be food for you. . . . But you must not eat meat that has its lifeblood still in it." He added: "For your lifeblood I will surely demand an accounting," and he then condemned murder. (Genesis 9:3-6, New International Version). According to that, blood had a symbolic meaning; it stood for life provided by the Creator and by treating blood as special, the people showed dependence on him for life. In addition, the Law repeatedly stated the Creator's ban on taking in blood to sustain life. "You must not eat the blood; pour it out on the ground like water. Do not eat it, so that it may go well with you and your children after you, because you will be doing what is right."Deuteronomy 12:23-25. By the other hand, some people think that this commands just applied in Moses law, and that law is not so important for the Christians. However, the first Christians were warned about the inappropriate use of blood, lets take a look on this; shortly after Christianity was founded some 2,000 years ago, believers were given the divine commandment to abstain from. . . blood. The prohibition was based, not on health concerns, but on the sacredness of blood. (Acts 15:19, 20, 29). Some argue that this God-given restriction applies only to the eating of blood, but the word abstain speaks for itself. If a doctor told us to abstain from alcohol, we would hardly feel at liberty to inject it into our veins. Contrary to how some today reason, God's law on blood was not to be ignored just because an emergency arose. Hence, precious as life is, our Life-Giver never said that his standards could be ignored in an emergency.

Clearly a moral principle was involved. Human blood has great significance and should not be misused. Secondly, theres the contamination risk, blood-borne disease worries conscientious physicians and many patients. Which disease? Frankly, you cannot limit it just to one; there are indeed many. After discussing the more well-known diseases, Techniques of Blood Transfusion (1982) addresses "other transfusion-associated infectious diseases," such as syphilis, cytomegalovirus infection, and malaria. It then says: "Several other diseases have also been reported to be transmitted by blood transfusion, including herpes virus infections, infectious mononucleosis (Epstein-Barr virus), toxoplasmosis, trypanosomiasis,

leishmaniasis, brucellosis, typhus, filariasis, measles, salmonellosis, and Colorado tick fever." So, not only the AIDS virus could be transmitted by blood, almost all the viruses are blood transmittable, that certainly increase the statistic risk to get ill by a blood transfusion. By the other hand, talking about the most common and scaring blood transmitted virus the AIDS; this virus was designated HIV, but some experts now call it HIV-1. Because they found another virus of the AIDS type (HIV-2). It can cause AIDS symptoms and is widespread in some areas. Moreover, it "is not consistently detected by the AIDS tests now in use here," reports The New York Times. (June 27, 1989) "The new findings . . . make it more difficult for blood banks to be sure a donation is safe. A presidential commission (U.S.A.) said that one such virus "is believed to be the cause of adult T-cell leukemia/lymphoma and a severe neurological disease." This virus is already in the blood donor population and can be spread in blood. The tragedy of AIDS has compelled scientists and physicians to take additional steps to make the operating room a safer place. Obviously, this has meant more stringent blood screening. But experts say that even these measures do

not ensure zero-risk transfusions. That means, that even tested donated blood is could transmitted AIDS or any other undetectable virus, it is a very big risk to take.

Early in the 20th century, scientists deepened man's understanding of the marvelous complexity of blood. They learned that there are different blood types. So, matching a donor's blood and a patient's blood is critical in transfusions. Because, if someone with type A blood receives type B, he may have a severe hemolytic reaction which can destroy many of his red cells and quickly kill him. Even blood that has been "properly" cross matched can suppress the immune system. While blood-typing and cross matching are now routinely, errors do occur. Every year people die of hemolytic reactions. The facts show that the issue of incompatibility goes far beyond the relatively few blood types that hospitals seek to match, in his article "Blood Transfusion: Uses, Abuses, and Hazards," Dr. Douglas H. Posey, Jr., writes: "Nearly 30 years ago Sampson described blood transfusion as a relatively dangerous procedure, [Since then] at least 400 additional red cell antigens have been identified and characterized. There is no doubt the number will continue to increase because the red cell membrane is enormously complex."Journal of the National Medical Association, July 1989. Scientists are now studying the effect of transfused blood on the body's defense, or immune, system. Therefore, it is understandable that some studies show that patients receiving blood are more prone to infection. The point is that although the the advances of the medicine are undeniable, the components en behavior, not just of the blood but the hole human organism is still a mystery, and it have been prove that the complexity of the human blood goes farther than three types; and the body responds to a transfusion is still like a lottery game.

Thankfully, there is an alternativebloodless medicine and surgery and many patients view it not as a last resort but as a preferred treatment, and with good reason. Stephen Geoffrey Pollard, a British consultant surgeon, notes that the morbidity and mortality rates among those who receive bloodless surgery are "at least as good as those patients who receive blood, and in many cases they are spared the postoperative infections and complications often attributable to blood. Doctors have now successfully applied bloodless techniques during operations and emergency procedures that traditionally required transfusions like major cardiac, vascular, gynaecological and obstetrical, orthopaedic, and urological surgery can be performed successfully without using blood or blood products. The alternatives techniques like; Fluids, ringer's lactate solution, dextran, hydroxyethyl starch, and others are used to maintain blood volume, preventing hypovolemic shock. Some fluids now being tested can transport oxygen. Drugs, genetically engineered proteins can stimulate the production of red blood cells (erythropoietin), blood platelets (interleukin-11), and various white blood cells (GM-CSF, G-CSF). Other medications greatly reduce blood loss during surgery (aprotinin, antifibrinolytics) or help to reduce acute bleeding (desmopressin). Biological hemostats, collagen and cellulose woven pads are used to stop bleeding by direct application. Fibrin glues and sealants can plug puncture wounds or cover large areas of bleeding tissue. Blood salvage, salvaging machines recover blood that is lost during surgery or trauma. The blood is cleansed and can be returned to the patient in a closed circuit. In extreme cases, liters of blood can be recovered using such a system. Surgical techniques, thorough operative planning, including consultation with experienced clinicians, helps the surgical team to avoid complications. Prompt action to stop bleeding is essential. Delays greater than 24 hours can greatly increase patient mortality. Dividing large surgeries into several smaller ones

decreases total blood loss. Surgical tools, Some devices cut and seal blood vessels simultaneously. Other devices can seal bleeding on large areas of tissue. Laparoscopic and minimally invasive instruments allow surgeries to be performed without the blood loss associated with large incisions. One advantage of bloodless surgery is that it promotes better-quality care. A South African legal journal says that in certain instances surgery without blood can be "quicker, cleaner and less expensive." It adds: "Certainly the aftercare treatment in many instances has proved cheaper and less time-consuming." These are just some of the reasons why there are currently more than 180 hospitals around the world that have programs specializing in bloodless medicine and surgery. That means that the bloodless surgeries are not only safer but even cheaper too.

If we imagine the worse situation, the case were someone has loses a lot of blood or has a terrible hemorrhages, it might seem logical just to replace it, but what is primarily needed is that the bleeding is stopped and the volume in his system be restored. That will serve to prevent shock and keep the remaining red cells and other components in circulation. Volume replacement can be accomplished without using whole blood or blood plasma. Various non-blood fluids are effective volume expanders. The simplest is saline (salt) solution, which is both inexpensive and compatible with our blood. There are also fluids with special properties, such as Dextran, Haemaccel, and lactated Ringer's solution. Hetastarch (HES) is a newer volume expander. By other hand, salvaging machines recover blood that is lost during surgery or trauma. The blood is cleansed and can be returned to the patient in a closed circuit. In extreme cases, liters of blood can be recovered using such a system. Collagen and cellulose woven pads are another methods used to stop bleeding by direct application. Fibrin glues and sealants can plug puncture wounds or cover large areas

of bleeding tissue. Thorough operative planning, including consultation with experienced clinicians, helps the surgical team to avoid complications. Prompt action to stop bleeding is essential. Delays greater than 24 hours can greatly increase patient mortality. Nowadays the blood transfusion is unnecessary, even in the emergency cases, there a lot of alternatives,

Skilled physicians who have accepted the challenge of applying this on Jehovah's Witnesses have developed a standard of practice that is safe and effective, as is proved in numerous medical reports. Physicians who provide quality care without blood are not compromising valued medical principles. Rather, they show respect for a patient's right to know risks and benefits so that he can make an informed choice as to what will be done to his body and life. We are not being naive in this matter, for we realize that not all will agree with this approach. People differ as to conscience, ethics, and medical outlook. Hence, others, including some doctors, may find it hard to accept a patient's decision to abstain from blood. Most people who for religious or medical reasons, refuse blood but accept alternative medical therapy do very well. They may thus extend their life for years.