Frequently Asked Questions

Center for Bloodless Medicine Surgery at University Hospitals Rainbow Babies & Children's Hospital is an innovative program that blends the individual values and interests of family with the latest medical and surgical techniques. The result is a healthcare environment that supports a family’s desire for pediatric care without the use of donated blood or blood products, when possible.

Why bloodless medicine?

For children, there are unique concerns associated with the use of donated blood, specifically due to their age. Although blood is as safe as it can possibly be, that safety is only within the limits of what is known today about blood. Many pediatricians feel that we could be transfusing the diseases of tomorrow today, the real possibility of transfusing blood borne disease that may not be known for years to come is a concern. Perhaps for an older adult patient the risk is less significant. But for pediatric patients who have a lifetime ahead of them the risk may be much more significant.

As more is known about bloodless medicine and surgery, research shows that in many cases the advanced techniques used in bloodless medicine and surgery allow the patient to recover quicker with a decreased risk of infection. Patients enrolled in the Bloodless Medicine and Surgery Program report increased patient satisfaction compared to patients who are not enrolled.

For some individuals the decision is based on broad considerations regarding the risks associated with donor blood, the unique medical condition of the patient, or a desire to prevent donor blood shortages for emergency use. So whether your choice for bloodless medicine and surgery is based on cultural or religious values, UH Rainbow Babies & Children’s Hospital is here to support and provide the highest level of bloodless care available.

What is bloodless medicine and surgery?

Bloodless medicine and surgery is an advanced way of providing medical care without using donated blood. Bloodless medicine uses state-of-the-art techniques that minimize a patent’s blood loss before, during and after treatment for many illnesses, so that donor blood transfusion may not be needed.

Bloodless Medicine and Surgery is accomplished by some of the following alternatives:

• Patient identification at all points of entry
• Minimal blood sampling
• Effective use of recombinant DNA products that stimulate the bone marrow to produce red blood cells and improve clotting time
• Use of additional hematopoietic therapies: which serve to restore iron levels, with applications such as iron, folic acid, and ascorbic acid to facilitate iron absorption and stimulate the production of red blood cells
• Minimally invasive surgery
• Preoperative acute normo-hemodilution

What are the benefits of bloodless medicine and surgery?

An accepted modern medical specialty, bloodless medicine and surgery technology began years ago in response to concerns about the nation’s blood supply.

Research in bloodless medicine and surgery, which has primarily focused on adults, has demonstrated that patients enjoy a reduced length of stay, improved outcomes and increased satisfaction when they receive bloodless medical and surgical protocols. In addition, bloodless medicine has been found to be cost effective.

What is unique about the Center for Bloodless Medicine and Surgery at UH Rainbow Babies & Children’s Hospital?

Bloodless techniques have been used for some time at UH Rainbow Babies & Children’s Hospital. Since 1998 the UH Rainbow Babies & Children’s Hospital’s Neonatal Intensive Care Unit has had a blood conservation program to minimize the use of blood and all blood products in infants.

In 1999 bloodless medicine at UH Rainbow Babies & Children’s Hospital took another step forward with the creation of the Center for Bloodless Medicine and Surgery. UH Rainbow Babies & Children’s Hospital is the first free-standing pediatric hospital in the nation to develop a bloodless program. Advanced bloodless techniques have been brought to UH Rainbow Babies & Children’s Hospital by tapping into the knowledge and experience of St. Vincent Charity Hospital, a hospital in the partnership between University Hospitals Health System and the Sisters of Charity of St. Augustine and one of the first in the nation to offer a Center for Bloodless Medicine and Surgery.

While the number of bloodless medicine and surgery programs in existence has increased dramatically over the past five years -- from 37 in 1994 to approximately 100 bloodless programs in the U.S. today—they continue to focus primarily on adults. UH Rainbow Babies & Children’s Hospital is unique in bringing advanced bloodless techniques to pediatric patients. The benefits that have been found effective for adults are now being applied to the care of children, and UH Rainbow Babies & Children’s Hospital is at the forefront of this advance.

Why do some people choose bloodless medicine & surgery?

The use of donated blood and blood products clearly has a necessary place in the practice of medicine. It is also clear that the use of donor blood is not entirely risk free. Patients and their families who request bloodless medicine often wish to take charge of their own healthcare. For some patients and families, the choice of bloodless medicine or surgery is based on cultural or religious values. Other patients and families base their decision on broad considerations including concern about the risks associated with using donor blood, the unique medical condition of the patient, or a desire to prevent donor blood shortages for emergency use.

For children, there are unique concerns associated with the use of donated blood, specifically due to their age. Although blood is as safe as it can possibly be, that safety is only within the limits of what is known about blood today. For example, there is the slight possibility that a blood-borne disease that is not yet known may be transfused today, but not become known for ten years. For an older adult patient, this risk is less significant. But for a pediatric patient -- who has a lifetime ahead -- the risk may be much more significant.

As more is known about bloodless medicine and surgery, research shows that in some cases the advanced techniques and technology used allow patients to recover more quickly and reduce the risk of infection. For pediatric patients with fragile immune systems, this is an important advantage.

How is bloodless medicine and surgery done?

The Center for Bloodless Medicine and Surgery at UH Rainbow Babies & Children’s Hospital uses proven, state-of-the-art technology and the latest scientific knowledge to care for young patients without the use of donor blood. The specialized techniques and equipment used focus on conserving and strengthening a patient’s own blood, and minimizing a patient’s blood loss.

Medical Techniques
These include the use of medications, vitamins and other tools that stimulate the body’s production of red blood cells or manage anemia in ways that support blood conservation during illness, and before and after surgery.

Erythropoietin
By giving a patient this synthetic hormone prior to surgery, the individual’s bone marrow is stimulated to produce more red blood cells which is beneficial to boosting the patient’s hemoglobin level before surgery.

Micro sampling
All lab tests are carefully monitored for necessity. Techniques that minimize the amount of blood and the frequency that it is taken for testing include: point-of-care testing and limited sampling in which very small amounts of blood are taken rather than the larger quantities routinely drawn in a hospital setting.

Volume expanders
By using these intravenous fluids to dilute or "water down" the blood, each ounce of blood carries a lower concentration of red blood cells. So, if blood loss occurs, the amount of red blood cells lost is reduced.

Surgical Techniques
These include the use of specific tools or techniques that conserve blood loss or enable the patient to use his or her own blood during a surgical procedure.

Advanced cell saver system
This is an extremely sophisticated system that carefully conserves and re-circulates a patient’s own blood. By collecting and re-circulating blood that would otherwise be lost during surgery, the use of donor blood may be avoided.

Autologous blood donation
Patients who will be having planned surgeries may donate their own blood (autologous) in advance of the surgery and have it stored. The blood may then be used for transfusion if necessary during the surgery.

Electrosurgical coagulator
This sophisticated tool has been used for many years to limit internal bleeding by clotting the patient’s blood during surgery.

Minimally invasive surgery
By its very nature, minimally invasive surgery can be seen as an approach to bloodless medicine and surgery. Using microscopic tools that minimize the body’s exposure during surgery also minimizes blood loss.

Skin monitor
A pulse oximeter is a devise used to track oxygen levels in the blood through the skin which helps monitor the patient’s overall well being during surgery.

What medical conditions can be treated with bloodless techniques?

Many common illnesses and conditions of infants and children may be treated with bloodless medicine and surgery. Bloodless techniques may be applied in the following specialty areas, as well as others:

• Cardiology & Cardiothoracic surgery
• Ear, Nose & Throat (Otolaryngology)
• General surgery
• Hematology
• Internal Medicine
• Neurosurgery
• Ophthalmology
• Orthopaedic surgery
• Vascular medicine & surgery

How can I find out more about bloodless medicine

If you are interested in whether your child’s condition can be treated with bloodless techniques, would like the names of physicians who use bloodless techniques, or are interested in a second opinion—please feel free to contact the Center for Bloodless Medicine and Surgery at 844-289-8978. Or, ask your doctor about Bloodless Medicine and Surgery at UH Rainbow Babies & Children’s Hospital.

State and Federal laws may impose limitations on the physician’s ability to withhold blood transfusions on neonates and children.

In addition, patients of University Hospitals MacDonald Women’s Hospital may want to inquire about the bloodless medicine and surgery options available to Ob/Gyn patients.

Will our family’s health insurance cover bloodless techniques?

Bloodless medicine is an accepted form of healthcare. If your health insurance is normally accepted at UH Rainbow Babies & Children’s Hospital, care from the Center for Bloodless Medicine and Surgery would be similarly covered. There are no additional costs for bloodless care.

Where can I get more information?

We are available to assist you in making decisions about care that may be right for you or your family. For help in selecting a physician to meet your needs, referrals or other assistance, please call 844-289-8978 or toll free at 877-222-8623. Or, you may send an e-mail inquiry at RainbowBabies.org/AskRainbow.