Bloodless Surgery in Gynecologic Oncology

Abstract

Bloodless medicine and surgery is an evolving field in the practice of medicine designed to avoid allogeneic transfusions. Although this field has largely developed in response to the growing needs of Jehovah's Witness patients refusing transfusions, all patients may potentially benefit from the avoidance of transfusions. The applications of bloodless techniques and strategies in the field of gynecologic oncology have been limited until recently, in part because of the generally large blood loss associated with gynecologic cancer surgeries. However, as advances in our understanding of bloodless surgery have developed and surgical techniques have been refined, the gynecologic oncology patient can now benefit from the avoidance of allogeneic transfusions. This review outlines bloodless surgery as it applies to gynecologic oncology patients and presents a structured approach to successfully managing these complex patients.

Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service

“…The evolution of bloodless surgery and medicine now offers Jehovah’s Witness patients an organized approach to surgery designed to minimize blood loss and to avoid blood transfusions. 4 , 8 Bloodless surgery is separated into three categories: preoperative; intraoperative; and postoperative interventions. 8 The preoperative process begins with a thorough history and a detailed physical examination.…”

“…Jehovah’s Witness patients and others wishing to avoid allogeneic transfusions now have access to many techniques designed to avoid allogeneic transfusion and to minimize procedure-related blood loss including normovolemic hemodilution and intraoperative autologous blood salvage (performed in a closed system without blood storage). 4 – 8 According to the Society for the Advancement of Blood Management, there are currently approximately 100 bloodless surgery centers across the United States. 9…”

Bloodless Surgery in a Jehovah’s Witness Patient with a 12.7-kg Uterine Leiomyosarcoma

“…Although no published studies have described an organized approach for bloodless surgery in patients with gynecologic malignancies, the results of this bloodless surgery experience on a gynecologic oncology service were presented at the 2006 International Gynecologic Cancer Society Meeting and the 2006 Society for the Advancement of Blood Management Meeting. 2 Several studies demonstrate the feasibility and application of preoperative measures (eg, erythropoietin administration) or intraoperative measures (eg, cell salvage) in patients undergoing gynecologic surgery desiring to avoid allogeneic transfusions. [3][4][5][6] This case demonstrates the successful implementation of a comprehensive bloodless surgery protocol in caring for a patient with a massive uterine leiomyosarcoma.…”

Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy?

“…31 In his recommendations in the wake of Canada's inquiry into the tainted blood scandal, Justice Horace Krever identified alternatives to blood transfusion a priority after thousands of blood transfusion recipients developed HIV and tens of thousands developed hepatitis C. 32 Bloodless surgery represents a combination of techniques throughout the perioperative period, with the common goal of minimizing or avoiding allogeneic blood transfusion. Strategies are employed preoperatively (autologous blood donation, iron and erythropoietin supplementation), intraoperatively (ICS, acute normovolemic hemodilution, antifibrinolytic drugs, surgical technique), and postoperatively (minimization of phlebotomy, conservative transfusion trigger, antifibrinolytic drugs, return of shed blood).…”