Camron Eddy remembers the day he and his wife, Tammy, walked into a Lansing doctor’s office to discuss their daughter’s surgery to remove her tonsils and adenoids.
The doctor brought up the possibility of the couple’s daughter, Olivia, needing a blood transfusion during surgery.
As Jehovah’s Witnesses, the Eddy family could not accept blood transfusions.
“He completely shut us down, told us good luck finding a doctor to work with us, shook our hand and ended the appointment quickly,” Eddy said. “We were dumbfounded that we would be treated that way.”
Haunted by this experience, Eddy reached out to his church’s hospital liaison committee, which referred the couple to David Sterken, CPNP, the program coordinator for the pediatric blood management program at Spectrum Health Helen DeVos Children’s Hospital.
“It was a world of difference in dealing with them,” Eddy said. “The doctor was very accommodating, very kind, very conscious of our feelings and beliefs.”
The doctor assured the family the medical team would be meticulous in their procedures and do everything possible to avoid problems with bleeding.
This is exactly the goal of the program, created in 1999 by Nabil Hassan, MD, a pediatric intensivist and the program’s director.
The innovative program, offered at only a few other children’s hospitals in the country, calls on hospital staff to do everything possible to minimize the need for children to be given a blood transfusion from the blood bank. Surgeons, anesthesiologists, specialists and other medical professionals work together to conserve blood and minimize blood loss whenever possible.
“They never promised they would not do a blood transfusion,” Eddy said. “But they said they would be very cautious and would keep us very aware and informed every step of the way. That level of comfort going into it meant a lot to us.”
While the idea for a blood management program originally came from Dr. Hassan’s work with Jehovah’s Witness families, it soon moved far beyond that.
Dr. Hassan’s research on the pediatric side of blood management showed there are nonreligious reasons some people do not want blood transfusions for themselves or their children. A different approach was needed.
“When our kids get sick, they are very vulnerable,” Dr. Hassan said. “At times, they might need interventions to save their lives, such as blood transfusions. These interventions should always be done in a judicious way. We have the means to avert so many blood transfusions, and to save the blood product for life-threatening situations.”
The pediatric blood management program at Spectrum Health Helen DeVos Children’s Hospital uses several strategies to minimize blood loss in children, including:
- Preventing and treating anemia or low hemoglobin, the primary reason children need blood transfusions.
- Detecting and treating preexisting bleeding disorders.
- Raising the thresholds where a blood transfusion is required, so the medical team can first try other treatments.
- Conserving and managing blood through effective techniques, such as drawing the minimum amount of blood for a test.
- Using techniques and medications during surgery that limit blood loss.
- Collecting a patient’s blood during surgery to give it back to the patient.
Caitlyn Curry, 4, recently visited the program’s infusion center to receive intravenous iron and a medication to boost her red blood cells to correct her anemia. Caitlyn has chronic issues with low iron, and her parents and doctors wanted to be sure it wouldn’t be an issue during two scheduled surgeries.
Her mother, Breanne Curry, said that while they are not Jehovah’s Witnesses and do not have religious convictions against blood transfusions, they know the risks and wanted to try to prevent it.
“This is a surgery where you can prepare, so why not prepare?” Breanne said.
Caitlyn was born with cloacal exstrophy, a birth defect resulting in her bladder and intestines being exposed. Her recent surgeries will prepare her to start kindergarten in the fall, her mother said.
The blood management program’s infusion center has made a difficult process easier for the family.
“For me, the nice thing about it is that somebody is looking at just that piece of it for her,” Breanne said. “Her pediatrician and her surgeons have a lot of other things to focus on with her. It’s comforting.”
Sterken said the blood management program at the hospital gets involved in a patient’s case when parents express concerns about blood transfusions, or when a patient has problems with anemia, as with Caitlyn. Sterken also works in conjunction with the hematology team if a patient has problems with excessive bleeding or clotting.
Jehovah’s Witnesses now comprise only about 5 percent of program participants, Dr. Hassan said. The largest percentage of program participants are patients with gastrointestinal diseases such as Crohn’s disease, ulcerative colitis and short gut syndrome.
Patients with these diseases typically have problems absorbing iron. While Sterken and doctors work hard to use other methods to keep these patients from getting anemic, sometimes it’s so bad they’ll need a blood transfusion.
The program was a success for Caitlyn: She didn’t need a blood transfusion during her first surgery, an orthopedic procedure during which doctors had to break her hips and adjust them with pins.
They’re hoping for the same success in her second upcoming surgery.
The program also resulted in a success for Olivia Eddy, now 10, who didn’t need a blood transfusion.
“Because we were coming from out of town, they kept her in the hospital for observation overnight and the doctor checked her the next day,” Camron Eddy said. “It went very smoothly.
“There were no complications,” he said. “It meant a great deal to us.”