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Recycled blood is better than donated blood for transfusions, Hopkins study finds

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Recycled blood is better than donated blood for transfusions, Hopkins study finds


Red blood cells

Yes, blood. During some surgeries, operating room personnel try to capture as much blood as possible and return the red blood cells to your system, instead of, or in addition to, donated blood from a blood bank. They find that patients have better outcomes when transfused with their own blood.


A Johns Hopkins University study, published in the June issue of the journal Anesthesia and Analgesia, explains one reason for that. As banked blood sits on shelves for as long as 42 days, the membranes of red blood cells become less  able to change shape and squeeze through the smallest capillaries to deliver critical oxygen to tissues.


“The smallest capillaries are five microns in diameter. Red blood cells are seven microns,” said Steven Frank, an associate professor in the Department of Anesthesiology at the Johns Hopkins School of Medicine, who led the research. In addition to its weakened ability to deliver oxygen, the red blood cells can sometimes plug those capillaries, he said


The irony is that blood banks sometimes face shortages of donated blood, and red blood cell salvaging, as it is sometimes known, is cheaper than using banked blood. Banked blood — whether obtained from the Red Cross, a practice followed by smaller hospitals, or banked at major facilities such as Hopkins — costs about $240 per unit, Frank said. Recycled blood costs about $120 for the plastic tubing and other equipment needed to salvage the first unit, but nothing more once the equipment is set up in an operating room and a person is brought in to run it.


Smaller hospitals may not have the equipment or personnel for such salvaging, but larger ones certainly do, Frank said. The technique, which can recapture 50 percent to 75 percent or more of a patient’s blood, can be used during heart surgery, vascular surgery, joint replacements, transplants, some Caesarean sections and even trauma surgery, he said.

“We do use the cell-saver blood,” Frank said. “I just think we don’t use it enough.  The banked blood is the easy way out. It’s always available.”


Recycling a patient’s blood became popular in the 1980s, when the risk of HIV in donated blood was higher. But now banked blood is considered so safe that getting HIV or hepatitis from it carries the same risk as being struck by lightning or killed in an airplane crash, Frank said.


Five large studies have shown that the amount of blood needed doesn’t affect the fresh vs. stored equation either, Frank said. In all of those studies, people receiving fresh blood were less likely, or no more likely, to suffer heart attacks, strokes, death or infections after surgery, he said.


In the Johns Hopkins study, researchers divided 32 patients into three groups. One received only recycled blood; one received mostly recycled blood supplemented by a small amount of banked blood; and one received recycled blood plus a larger amount of stored blood. The banked blood had been stored an average of 25 days.


The patients receiving banked blood did worse than those who received only their own recycled blood, the study showed, a condition that lasted for about three days after surgery.


“People say blood saves lives, and it does if you’re hemorrhaging,” Frank said. But it’s also “very clear that the longer they’re stored in the blood bank, the less functional the red blood cells are.”



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More about stored blood: a study out of Duke University that found that transfusions increase your risk of heart attack and death. According to the study, the problem is that the oxygen-transporting efficacy of stored blood begins to decay almost immediately. This is because stored red blood cells become deficient in nitric oxide, thus limiting their ability to get oxygen to tissues that need it. Nitric oxide opens up blood vessels, which allows oxygen carrying blood to reach the tissues served by those vessels. In vitro studies show that levels of S-nitrohemoglobin (the molecule that carries nitric oxide in the blood) decline rapidly in stored red blood cells. There is a 70% drop in the first day of storage. By the twenty-first day, the molecule was below the level of detectability. In the U.S., red blood cells can legally be stored up to 42 days before blood banks are required to discard them. But the problem is even worse than it sounds. Not only is transfused blood deficient in nitric oxide, but because it's deficient, it actually sucks nitric oxide out of the surrounding tissue to compensate. This causes that tissue to constrict and become deoxygenated. If that tissue happens to be heart muscle, you have a real problem.

The study which appears in the March 20th issue of the New England Journal of Medicine, essentially confirms the Duke study. It reports that heart surgery patients who receive transfusions with blood that has been stored more than 14 days are far likelier to suffer complications and may face significantly reduced survival rates -- both short and long term. The study of more than 9,000 patients in the US has shown that those given blood more than 14 days old are 65 percent more likely to die before discharge and 50 percent more likely to die within a year. Recipients of older blood are also at much higher risk of blood poisoning and multi-organ failure according to the survey conducted at the Cleveland Clinic in Ohio. Considering that nearly half of heart surgery patients receive transplants and that the FDA allows blood to be stored for up to 42 days before it must be discarded, this news carries major implications for any heart surgery patients...and their doctors. In point of fact, transfused blood usually takes several days to even reach a hospital. That means that the average patient getting a transfusion is quite likely receiving blood that is pushing two weeks old -- with a sizeable number (60% of O RH negative, for example) receiving blood that is up to four weeks old.

This info was from noblood.org.

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