Contact us
Phone: 253-697-2722
Email: [email protected]
Fax: 253-697-5131
You may also page us at 253-243-3998, available 24/7
Transfusion-Free Program
For many patients, the use of blood products in their medical care is not an option. The MultiCare Transfusion Free Program understands and respects the wishes of patients who resolutely refuse to receive blood transfusions, even in life-threatening situations. Bloodless medicine is a safe and effective way to treat patients without the use of blood or blood products.
Our goal is to provide quality, effective health care while respecting the values, dignity, and beliefs of all who visit MultiCare. Transfusion Free Program patients can depend on the commitment of hospital staff to provide care while always respecting the patient’s informed decision to refuse blood transfusions.
We employ scientifically sound, evidence-based conservation practices to improve patient outcomes by managing and preserving each patient’s own blood supply, eliminating risks associated with blood transfusions, and promoting patient safety and empowerment.
How it works
The Transfusion Free Program provides health education to assist patients with understanding the available bloodless treatment options, and then thoroughly documents the verified acceptable blood alternatives in the electronic medical record.
Program advocates collaborate with appropriate hospital services regarding the patients’ bloodless choices, closely monitors progress during hospitalizations, and provides consultation as requested.
Advocates are available 24/7 (Please see contact information at the top of the page).
Blood management techniques
There are many benefits to a bloodless approach. Research shows that patients who do not receive blood transfusions recover more quickly, experience fewer infections and complications, and have shorter hospitalizations overall.
We use state-of-the-art blood conservation devices, pharmaceuticals, and meticulous surgical techniques to minimize blood loss during medical and surgical interventions. Advances in equipment and technology have allowed physicians to safely and successfully perform many procedures, ranging from routine to complex, without blood transfusions.
Here are some of the available blood conservation strategies frequently utilized:
Pharmaceuticals
- Medication to stimulate blood cell production
- Hemostatic agents to reduce blood loss
- Intravenous iron infusions for anemia
Anesthesia
- Hypotensive anesthesia to decrease operative blood loss
- Maintenance of normothermia to reduce clotting issues
- IV fluids to maintain fluid balance
Lab work
- Use of low-volume tubes
- Minimal amounts of blood taken for testing
- Batching lab tests to reduce the amount of blood needed
Surgical techniques
- Embolization of bleeding vessels
- Electrocautery
- Harmonic scalpel
- Topical hemostatic agents
- Argon beam coagulator
Frequently asked questions
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Why refuse blood?
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Patients may have a strong religious conviction against receiving blood transfusions. Some may have personal preferences against receiving donor blood due to the risk of bloodborne diseases and transfusion reactions.
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Why limit the use of blood?
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Scientific evidence shows that overall, patients who avoid blood transfusions tend to have lower rates of most serious postoperative complications (e.g., heart attack, stroke, infections), immunological complications, allergic reactions, and bloodborne illnesses.
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What does a Transfusion-Free Program advocate do?
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- Advocates for patients’ blood product avoidance or restriction directives
- Documents acceptable blood alternatives in the electronic medical record
- Offers information on blood alternatives and blood sparing techniques
- Promotes best practices in blood conservation
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How can I best advocate for myself or a family member?
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- Document your medical and blood-related choices in an Advanced Directive/Durable Power of Attorney for Healthcare
- Inform your medical providers about your objections to blood transfusions and if you desire the use of alternatives in your care
- Ask your medical providers if you have anemia, or low blood counts
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Where do blood derivatives come from and what do they do?
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Glossary of Alternatives to Blood Transfusion (“Minor Fractions”)
Download a PDF of this glossary
Alternatives issued by Pharmacy Services:
- Albumin: Albumin is a protein produced in the liver and distributed throughout the body via the circulatory system. This protein is fractionated from plasma of healthy human donors and prepared for treatment to restore blood volume when needed. It is often used to treat shock as a volume expander in emergent situations.
- Erythropoietin (EPO, Epoetin alfa, Procrit) products sometimes contain a small amount of albumin for stabilization. Erythropoietin is a hormone that promotes red blood cell production in the bone marrow. This medication is used to treat anemia and may take 2-4 weeks to show effectiveness.
NOTE: Aranesp (darbepoetin) and Retacrit are versions that do not contain albumin - Immune Globulins: Immune globulins are various proteins that act as antibodies to infection. These antibodies respond to bacteria, viruses and/or other foreign substances in the body. Immune globulins are fractionated from plasma and pass freely between mother and fetus. These antibodies are rarely used for healthy patients, except in the case of certain vaccines. Most are familiar with RhoGAM, given to Rh negative mothers whose blood is incompatible with their baby’s. Immune globulin preparations are also used to treat conditions such as Cytomegalovirus infection (CMV), Kawasaki disease, Immune Thrombocytopenic Purpura (ITP), and certain animal bites.
- Clotting Factors (Humate-P, K-Centra, Thrombate): These products are proteins that control bleeding. They are fractionated from plasma and often suspended in a solution for treatment as needed. Many different clotting factors work together in a series of biochemical reactions to stop bleeding.
Alternatives available during surgery:
- Intra-operative blood salvage (Cell Saver) – Continuous Closed Circuit Loop ONLY: Frequently used during cardiothoracic, vascular, and spinal surgery, the Cell Saver or Autologous Blood Salvage procedure recovers blood “lost” during surgery, allowing for its immediate re-infusion to the patient, via a continuous circuit and without interruption. If agreeable with this procedure, advise your surgeon that you want this device prepared and ready to start when appropriate during surgery.
- Surgical Sealants (Tissue Adhesives, Fibrin Glue, Hemostatic Agents): These products are proteins fractionated from plasma and usually used during surgery to stop surgical site bleeding. If agreeable to this these alternatives, advise your surgeon that you want this available and implemented during surgery.
Blood Products and Derivatives chart
Jehovah’s Witnesses’ chart of Minor Fractions/Conscience Matters
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How can I prepare for bloodless medicine or surgery?
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- Discuss your blood avoidance directives with your medical providers as soon as possible, so an appropriate treatment plan can be created.
- Speak with your medical providers about testing for anemia (and treatment if necessary) well in advance of your procedure.
- Remember to bring your Durable Power of Attorney/Advanced Healthcare Directive document to your appointments and procedures.
Contact us
Phone: 253-697-2722
Email: [email protected]
Fax: 253-697-5131
You may also page us at 253-243-3998, available 24/7