Hospital Liaison Committees, Letter 12/10/13: Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the "Seville Document"

by hildebrando 5 Replies latest watchtower medical

  • hildebrando

    Concealment of information and biases. "Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the "Seville Document"" in English:

  • ILoveTTATT

    This is an amazing post that got missed!!

    Marvin Shilmer and anyone in ajwrb, I am sure you would be interested in this!!

  • problemaddict 2
    problemaddict 2

    Can anyone give me the english redux? :)

  • Simon

    Google Translated:

    This is another card that comes from "the land of lakes and volcanoes" by our comrade PyC. thank you, friend! . We are confident this information will be invaluable for the whole brotherhood PyC presents this letter as follows:

    The second document, colloquially called 'Document Sevilla' is a much deeper analysis of the application of transfusion alternatives in different situations, the most common, with the respective recommendations for each of them, much better documented and technical . The paper brings together and updates the recommendations made by the experts. According to the letter guidelines for use are given, there are at least two points that do not usually play in favor of the position of the organization, such as preoperative autologous blood donation and EPO administration in patients critics. Therefore, the document is not to be distributed to physicians contacted, only it's easier to be the knowledge of the members of the CHS and the points agreed to support the use of alternative use.

    As you read this I wonder, what about the " informed consent ", argues that the Organization between authorities conflict arises when a doctor? Do you practice with patients witnesses by pointing out the risks of alternative medical treatments to blood? Consider the letter point by point:

    Warmly them attached for Article 2013: Document "Sevilla" Consensus on Alternatives to Allogeneic Blood Transfusion , recently published in the Spanish journal Hospital Pharmacy .

    Why not make this information known to the entire guild with the same "gusto" with which it was sent to the Hospital Liaison Committees (CEH)? Could not get in Awake! or or supplement Our Kingdom Ministry ?

    This is a guide prepared by experts from six scientific societies that contains explanations of techniques and drugs that avoid allogeneic blood transfusion. Provides recommendations based on well-designed studies , so it may be of great interest to practitioners of different medical and surgical specialties. The document has been published simultaneously in four medical journals: Hospital Pharmacy, Spanish Journal of Anesthesiology, Intensive Care Medicine and an English version in Blood Transfusion .

    The truth is that there is a big difference between an amateur paper written by undocumentedRetamales Avelino , which only highlights the benefits of medical alternatives to blood, and this article by medical experts in the field, which has come to be translated into English as Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the "Seville Document".

    Please keep in mind the following comments:

    The work focuses on alternatives to transfusion of red blood cells, but does not discuss how to avoid the use of the other major components of the blood.

    Warning that is deemed necessary to give the CEH, which could easily use this document with doctors treating cases where the use of the other major components of blood is necessary ... which shows the degree of beginners (and possible ridicule ) to doctors.

    On page 213 a section titled "Preoperative Autologous Blood Donation (DPSA)" appears. It is important for physicians to know that this alternative is not acceptable to Jehovah's Witnesses.

    And what about the "informed consent"? Why through this letter is rejected a priori this alternative, speaking for all Jehovah's Witnesses? Let's look at the section in question:

    " Preoperative Autologous Blood Donation (DPSA)

    The DPSA is a form of autotransfusion consisting of extraction, in the days or weeks prior to the intervention of one or more units of the patient's own blood . These units undergo serological screening and storage , fractionation followed or not, and reinfusion to the patient during surgery is performed and / or in the immediate postoperative period. "

    "Preoperative autologous blood donation

    Preoperative autologous blood donation (Pabd) is a modality of autotransfusion Consisting in the withdrawal of one or several units of the patient's own blood, in the days or weeks prior to the intervention. These units undergo serological screening and storage, and May be reinfused into the patient During the procedure or in the immediate postoperative period. "

    We understand that, although there is no blood transfusion others involved, the fact that blood is drawn in advance, 'viola' the application that makes the Organization of the Mosaic Law regarding 'spill the blood and cover it with earth' Leviticus 17:13 . But what is said about the blood salvage and hemodilution?

    W89 *** third p. 31 Questions From Readers ***

    "What's a hemodilution induced? Some surgeons believe that it is advantageous to dilute the patient's blood during surgery. Hence, the principle of direct operation some blood storage bags outside the body of the patient and replace the blood with fluids blood not, then allowed the blood to flow back to the patient Since Christians do not allow them to store blood, some doctors have made ​​an adaptation of this procedure by organizing the team in a circuit that is constantly connected with. patient's circulatory system Some Christians have accepted this,. others have refused Again, each person has to decide whether to. consider diverting their blood in a circuit such as hemodilution resembled the flow of blood by a lung machine, or if blood would like blood that has come out of the individual blood and therefore should be eliminated.

    A final example of using the patient's own blood involves blood recovered for reuse during an operation. Equipment used to aspirate blood from the wound, pumped by a filter (to remove clots or other material) or centrifugal (to remove fluid), and then insert it again in the patient. Many Christians have deeply concerned about the continued recovery in the blood that the blood flow is briefly interrupted. However, as already mentioned, more Bible would worry about if the blood flow to a wound or operative is not yet part of the person . Does the blood has flowed from his circulatory system to injury such blood should be 'shed', as mentioned in Leviticus 17:13? If the person believes so probably refuse to permit such recovery of blood. However, another Christian (who also allow blood that did flow from his person would be stored for some time and then again introducírsele in the body) could conclude that a circuit with recovery in one operation, with subsequent reinfusion not violate his conscience educated . "

    What real difference between the preoperative autologous blood donation and hemodilution and blood recovery, except that the time difference is stored blood outside the patient's body? In the case of the former prohibited, may be days or weeks. In the case of the other two, allowed, it may be hours or minutes. Rationally, it is practically the same. Theologically, since the biblical passage in question has nothing to do with medical procedures of the century, at least the interpretation should be consistent: all alternatives of the same type are accepted (as in all cases we speak of a reinfusion of the same patient's blood) is accepted or no. There is nothing in the passage that allows consistently discriminate between these three alternatives based on the duration of storage of blood. Now, on analyzing the letter:

    The authors do not recommend the use of recombinant human erythropoietin (rHuEPO) in critically ill patients. In Section 3, page 225, it is stated: "We do not recommend the use of rHuEPO to treat anemia and reduce transfusion rate." Although some exceptions are listed, this recommendation could make some doctors discard the use of rHuEPO in critically ill patients and the elderly.

    In this regard, the paper digs deeper into the case to raise the risks:

    "Various government agencies (FDA, EMEA and Competent Authority) have issued warnings about the association between the use of rHuEPO and the increased risk of thromboembolic events and mortality in patients with long-term treatment for anemia due to chronic renal failure or cancer chemotherapy and in patients without orthopedic surgery profilaxistrombo-embolic "

    Edith Morales's case illustrates this risk well. The judgment of the Court of Appeals of Santiago of 2008 tells us their health: "Edith Morales Orellana, 52-year-old, who is hospitalized in the Clinic Indisa suffering from multiple leukemia ... who in the course of their disease an acute acalculous cholecystitis, surgical management of disease, and due to complications related to the condition of the patient must be connected to a mechanical ventilator and transferred to the Intensive Coronary Care Unit. " Her husband did not witness, went to Court is aware that alternative treatments increased the risk of mortality, so that you will be given a blood transfusion, despite the verbal and notarial refusal of his wife.Given a television interview the husband explains: "Consider the treatment start. Transfusion, then came a chemo, then another series of transfusions and chemo Because, well, my wife made ​​him chemo, but risking that the hematocrit of 4 ... A no person can make a chemo 4 hematocrit, then that was finished faster The faster over So I had to follow the steps:.. transfusion and then came a chemo Transfusion and other chemo. " (Statements from 2:35 minute of the video below).

    This case is the 2008 and 2013 Document Sevilla is, however, whether the risks of alternatives to blood were well known by the husband of Edith Morales, is likely to know them, too CEH members advising appropriate to the medical staff. The question is: How much knew Edith, by members of the CHS, the risk to her life to be taking cancer chemotherapy without blood? If she was aware of all the risks and decided no pressure, we have nothing to object. But if he did not decide based on all available medical information, or if you received pressures CEH to be decided by the alternatives, or if they occurred both at once ... the reader to judge. now in 2014 and thanks to this letter, we have no doubt that the Organization CEH and manage this information. We wonder: Faced with the deadly risks involved with treating cancer with chemotherapy without blood, to what extent the CEH will tell the patient the risks? If the witness learns of this and decides transfused, will receive pressure from the CEH? This approach would it violate the "informed consent"? Since contains some points not very favorable, we are not recommending a distribution campaign . We encourage you to become familiar with its contents and discuss at its next meeting as a Committee of Hospital Liaison. They are free to use it to handle cases, highlighting specific points that support his argument . They can also share it with some of its medical consultants and collaborators. I have to be honest with you readers and I can not help but tell how dark it is this paragraph. This document, like the Organization itself recognizes in this letter was "drafted by experts from six scientific societies" and "provides recommendations based on well-designed studies" "of techniques and drugs that avoid blood transfusion" ... and a campaign of widespread distribution is not recommended because it "contains some very strong points"? You mean that the Organization tells doctors through the CEH only what suits the cause of alternatives to blood? That's right: You only have to use the Document de Sevilla "highlighting specific points that support his argument." It may be shared, but only with some doctors, "consultants and collaborators", ie only supporters physicians with views of the Organization regarding blood. really this biased act under investigation for CEH towards medical staff, leaving many doubts about the kind of information that can give you the control patient ... What's consent informed and self-determination promoted by the Organization to justify the refusal of blood? Are these legal principles also apply in the case of the alternative treatments? Are we not a case of concealment of information by the Organization of the risks of alternative procedures of blood?

  • Londo111


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