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A blood-recoverymachine known as acell saver, seen hereduring a prostateoperation, suctionsoff blood, cleans itand returns it to thepatient

In one especially difficult case that Shanderoversaw at Englewood, 11-year-old CristaliRodriguez came in with a rare pancreatic tumor,one of only 300 documented cases worldwide.

Doctors in Philadelphia had declined to perform aWhipple procedure, a complex reconstruction ofthe digestive tract rarely performed on a child.Rodriguez's parents had refused a bloodtransfusion, and the girl's doctors felt that withoutit the operation was even more risky. Undeterred,Englewood surgeons did a 10-hour bloodlessWhipple. There were no major complications, anda week later Cristali was eating pizza. Soon afterher discharge, she was back in school.

Up to now, Jehovah's Witnesses, who have longdemanded equal medical care without having tocompromise their religious beliefs, have made upsome 90% of those who seek the bloodlesstechniques. But increasing numbers of otherpatients today refuse transfusions out of fear ofblood-borne diseases such as aids and hepatitis, notto mention unidentified viruses.

Their concern is not always misplaced. Bloodtransfusions, while safer today than in the past, arenot risk free. The chance of contracting aids from aunit of blood, for instance, is 1 in 500,000, and 1 in103,000 for hepatitis C, according to the NationalInstitutes of Health. The risk becomes greater asmore units are transfused. "If you get 10 units ofblood, the risk of hiv infection becomes 1 in50,000," says George Nemo, leader of a groupinvestigating transfusion medicine at the NationalHeart, Lung and Blood Institute. "If you're in anautomobile accident, and you need 100 units,you're down to one in 5,000." Even when donorblood is deemed safe, if blood of the wrong group

is transfused by mistake, recipients may sufferkidney failure, shock and clotting difficulties.Differences between donor and recipient platelets,white cells and plasma proteins can also causereactions. Even donating one's own blood for useduring surgery can be hazardous if the blood ismishandled.

Other factors make bloodless surgery increasingly

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attractive. Transfusions can suppress the immunesystem, for example, leaving a patient open toinfection, slower healing and a longer recoverytime. "Also, banked blood, after it's cooled andstored, doesn't have the capability of fresh blood totransport oxygen," says Shander. "We're justbeginning to understand what it is we do when wegive a transfusion." Finally, there is the cost: ataround $500 for each transfusion, plusadministrative add-ons, the total bill comes tobetween $1 billion and $2 billion annually, morethan enough incentive to consider alternatives.Already, Englewood Hospital's managers claim,they have cut blood usage 20% and racked upsavings in labor costs by lowering infection ratesand shortening hospital stays.

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