RESPONSE TO "BLOOD TRANFUSIONS" (#124)

(Investigator 127, 2009 July.  One paragraph is here revised.)



INTRODUCTION

Blood Transfusions (#124) contains, despite being written in 1973, better statistical comparisons of surgery survival rates with and without blood transfusion than anything published by the Watchtower Society (WTS).


BLOOD

Fourteen millions units of blood are dispensed to 4,800,000 patients in the USA every year. (Motluk 2007)

Collected blood is centrifuged into layers. The top layer is yellow plasma, rich in platelet-cells important in clotting. The bottom layer is red cells which carry oxygen. The layers are packaged separately because patients require different blood components and because optimal storage temperatures and safe storage times differ for different components.

Focus magazine says:
A healthy adult has between 3.8 and 5.6 litres of blood. You can lose up to 15 per cent of your total volume rapidly without any immediate effects… At around 40 per cent loss, your blood pressure is too low to refill the heart chambers and the heart goes into ventricular tachycardia (a fast rhythm that can be fatal). (2008 March, p32)
Blood loss of 50% is survivable if quickly replaced with blood alternatives (such as Ringer's Lactate mentioned in the 1973 article). Blood alternatives don't carry oxygen; greater than 50% blood loss leaves the body with insufficient haemoglobin to maintain life.

1960s/1970s technology included hyperbaric oxygen therapy. After infusion of a blood alternative the patient was placed in a pressurized oxygen chamber. This enhanced the gas exchange between blood and tissues. Several JWs survived near 70% blood-loss by this method.
 
Some patients, however, lose more than 70% of their blood and require large transfusions to survive. Westphal (2005) lists:

Cancer Up to 8 pints per week
Hip replacement surgery Up to  5 pints
Brain surgery Up to 10 pints
Heart surgery Up to 25 pints
Car crash / gunshot injury Up to 50 pints
Liver Transplant
Up to 100 pints
  


RISKS

JWs emphasize the "risks" of blood transfusions. Everything, however, has risks — even eating food since the eater may choke, suffer allergic reaction, or be poisoned. If we try to save lives by banning food, we'd all die from starvation! Therefore "risks" are not sufficient reason for avoiding something. Rather, we need to consider the consequences of various actions and estimate comparative risks.

Transfusion-transmitted hepatitis infected hundreds of thousands in the 1970s. But those numbers have gone way down. Also in the 1970s-1980s 4670 British haemophiliacs got hepatitis-C from infected blood (1243 of these also got HIV). By 2009 about 2000 had died. However, safeguards against hepatitis-C and HIV were subsequently set up. The Advertiser reported on a two-year enquiry and said: "Steps to safeguard blood products against HIV and hepatitis C have been in place since 1985." (2009, February 25, p10)

Westphal (2005) lists current risks in the USA: 

POSSIBLE EVENT RISK
HIV or Hepatitis C infection 1 in 5,000,000 transfusions
Death from bacterial infection or getting the wrong blood 1 in 700,000             "
Hepatitis B infection 1 in 100,000             "
Bacterial contamination 1 in 10,000               "
Breathing problems due to immune reaction 1 in 5,000                  "
Mistakes such as receiving the wrong blood 1 in 400                      "


There's also a small risk of catching several other diseases — researchers are now working on methods of stripping all viruses, parasites and bacteria out of donated blood in one swoop.

Small risks are acceptable if the alternative is bleeding to death. Westphal says: "Theoretical risks aside, blood is one of the safest medical products around…"


ARTIFICIAL BLOOD

Artificial blood or "blood substitutes" carry oxygen and carbon dioxide and in that way "substitute" for blood.

An artificial blood called Fluosol-DA was used on patients in 1980. (Awake! 1980 8/8) In 1985 clinical trials stopped because Fluosol-DA: "didn't carry enough oxygen to vital organs and didn't stay in a person's system long enough to keep him alive until natural production replenished red blood cells." (The Watchtower 1985 4/15)

Although artificial blood saved some JWs, others died. The British newspaper The Guardian (1993, March 12) reported that Yvonne Leighton bled to death after childbirth although blood substitutes approved by JWs were administered. The report quoted Dr. Arun Choudry, "I am positive her life would have been saved if she had accepted blood."

Carlton Johnson, 25, was struck by a car. The Dallas Morning News (1993, July) quoted Dr. Robert Simonson that with a blood transfusion: "his chances of survival were pretty good…" A blood substitute was infused but lacked the clotting factors that could stop the bleeding. Dr. Simonson has seen 20 JWs refuse blood during his 11 years of emergency-room service: "In most cases the patient died."

New Scientist reported:
Charles Natanson of the National Institutes of Health in Bethesda, Maryland, analysed trials of the five main blood substitutes used when real blood was not available. He found that patients were 30 per cent more likely to die if they received the substitutes instead of a salt or starch solution, and nearly three times as likely to have a heart attack… (2008, May 3, pp 6-7)
The New Scientist report is based on an analysis (by Natanson et al 2008) of 16 clinical trials, involving 2700 patients, on the safety of hemoglobin-based blood substitutes. Hemoglobin-based blood substitutes are: "infusible oxygen-carrying liquids that have long shelf lives [and] no need for refrigeration or cross-matching."


NEWLY RECOGNIZED RISKS

In the past, blood transfusions killed more people than was recognized because delayed consequences were not attributed to the transfusions. Motluk (2007) reported:
But while blood transfusions undoubtedly save many lives, over the past five years, several studies have found that patients who received transfusions were also more likely to suffer heart attack, heart failure, stroke and death.
Red blood cells sense the level of oxygen in their surroundings and, when levels are low, release nitric oxide to open up blood vessels and allow more oxygenated blood to flow through. Banked blood, however, loses much of its nitric oxide within hours — and yet may be stored up to 42 days! Thus a major purpose for blood transfusion, to supply oxygen to tissues, is partly frustrated — the tissues are starved of oxygen instead.

Motluk says the problem would be solved if blood banks added nitric oxide to red blood cells and suggests this be made a standard procedure.

Nowak (2008) says, "Blood doesn't always save lives" and "transfusions can actually harm many patients." She explains that transfusions involving red blood cells are "linked to higher death rates in patients who have had a heart attack, undergone heart surgery, or who are in critical care."

The risk increases the longer the blood is stored. Stored blood undergoes chemical changes: nitric oxide levels drop; red blood cells become stiff and less able to move through capillaries; transfused blood may weaken the patient's immune system:

For almost 9000 patients who had heart surgery in the UK between 1996 and 2003, receiving a red cell transfusion was associated with three times the risk of dying in the following year and an almost sixfold risk of dying within 30 days of surgery.


ADDITIONAL COMMENT

The 1973 article had inadequate referencing. The River of Life is quoted without author or date.

A claim of 99 survivors out of 100 heart surgeries gives Awake! (August 8, 1970) as the reference. Looking it up we find that Awake! quotes The Sentry News (Slidell, Louisiana), where Dr Pearce says: "We recently used this technique in 100 consecutive open heart surgeries for congenital heart defects…and there was only one mortality."  The American Journal of Cardiology reference for 39 survivors our of 42 heart surgeries lacked date and page but has been found  February 1972, pp 186-189.

The statistics for heart surgery survivors (in the 1973 article) are interesting but inconclusive. A scientific approach — which can't be done for ethical reasons — would match pairs of patients according to health, age and type-surgery and employ blood transfusion for one of each pair and alternative treatment for the other.  

Besides rejecting blood transfusions JWs don't eat meat if the animal was not "properly drained of blood", or eat "blood pudding", or feed such products to pets, or use medicinal leeches. Leech therapy is used when circulation is poor after major surgery. (Recently Australian surgeons reattached the hand of a surfer mauled by a shark, and used leeches to maintain blood circulation:-  The Australian 2009, February 25, p3)

Coghlan (2008) reported:
Blood transfusions may one day be a thing of the past thanks to the creation of the first functional red blood cells grown in the lab. The cells were grown from human embryonic stem cells (ESCs)… The breakthrough raises the prospect of mass-producing supplies of the "universal donor" blood type O-negative, which…can be safely transfused into any patient…
JWs reject storing their own blood for re-infusion. Therefore their Hierarchy would probably also rule against infusing blood produced from stem-cells.


BLOOD OR NO BLOOD?


Investigator #12 estimated that 2,800 Jehovah's Witnesses had died needlessly since 1944 when the anti-blood doctrine began.

This estimate was based on four JW deaths in South Australia and multiplying 4 x 700 for a worldwide estimate (since 1/700 of all JWs worldwide lived in SA). In #75 I suggested the South Australian count might have reached six, giving a new world estimate of 6 x 700 = 4200

The sample of four (or six) is too small for a valid calculation. But it's better than nothing. A similar calculation using New Zealand estimated 800 JW deaths worldwide. In both cases it's uncertain whether every JW death from blood loss is included.

Some commentators claim the doctrine kills thousands every year. Most Internet lists of JW deaths, however, are short. My list in #75 is longer than most, but had only about 150 individuals.

JW congregations report to headquarters monthly and also post copies of pertinent media reports. The WTS therefore knows of all JWs who died from blood loss — but has never published the data.

The Watchtower 1993, October 15 says: "Any medical risk of refusing blood is probably less than the risks involved in accepting blood transfusions." The article quotes a doctor who claims that side-effects make blood transfusions not worth it. The doctor also said that forgoing blood transfusions adds "0.5% to 1.5% mortality to the operative risk." Since millions of JWs have medical operations, the added mortality implies many deaths!

Let's use the 4200-estimate to calculate whether blood or no-blood is safer. Blood-transfusions sometimes kill, therefore some of those estimated 4200 who died from blood-loss would have died from their transfusion had they accepted. But how many?

The best anti-blood case, the best pro-JW case, using the highest injury-from-transfusion estimates cited in the 1973 article, is that blood transfusions injured 10% of recipients and killed 1%.

If the estimated 4200 JWs who died from rejecting blood had accepted blood, then the risks for taking blood would apply. In that case 1% of those 4200 or a total of 42 would have died. And about 10%, or 420 persons, would have gotten a disease and recovered.

Thus the best anti-blood case, using the highest estimates for death and injury from blood transfusions, refutes JWs.


COMMITTEES


In 1979 the WTS introduced "Hospital Liaison Committees" consisting of JW elders who intervene in hospitals and courts on JW patients' behalf. The Committees are armed with a loose-leaf handbook titled Family Care and Medical Management for Jehovah's Witnesses which constantly gets updated.

The Committees:
•    Exert pressure on wavering JW patients;
•    Coach JW patients and families on what to say;
•    Hinder doctors from seeking court orders and judges from declaring JW child-patients wards of the state.

The Committees have phone access to "Hospital Information Services" at the New York headquarters which maintains a medical data base and can fax new information within hours.

In 1993 about 850 committees composed of 4500 elders existed in 65 lands.  (Awake! 1993, 11/22)


CONCLUSION:

Blood transfusions come with risks. Therefore transfusions of only one pint to improve wound healing or improve patients' color — often done 50 years ago — might now constitute malpractice.

The JW stance however, that given today's technology no blood transfusions are necessary, is even sillier. A reasonable claim is: "at least 25 per cent of blood transfusions that are done could be avoided…" (Hoffman 2007)


I've ignored the theological comment of the 1973 brochure. However, the history of the anti-blood doctrine, including theology, was discussed in #10 and #12.

(BS)


REFERENCES:


Coghlan, A. New Scientist 2008, August 23, p10
Hoffman, L. The Weekend Australian Health, 2007, June 16-17, p18.
Motluk, A. New Scientist 2007, October 13, p18
Natanson, C.; Kern, S.J.; Lurie, P.; Banks, S.M.; Wolfe, S.M. JAMA 299 (19) May 21, 2008: 2304-2312
Nowak, R. New Scientist 2008, April 26, pp 8-9
The Advertiser, 2009, February 25, p. 10
Westphal, S.P. New Scientist 2005, July 23, pp 33-36.


The history of Jehovah's Witnesses and their "Bible truth" examined on this website:

 http://users.adam.com.au/bstett/

http://ed5015.tripod.com/