Compiled by Merry Sue Baum, Eve Jacobs and Margaret Keenan
Illustrations by Steven Salerno
Eureka! They've Done It Again!
Researchers at UMDNJ-Robert Wood Johnson Medical School announced on June 26 that they had identified a gene mutation clearly linked to the development of some cases of Parkinson's disease. They worked in collaboration with investigators at the National Human Genome Research Institute of the National Institutes of Health, the University of Naples and the University of Patras Medical School in Greece.
This discovery is a landmark in understanding why brain cells malfunction and die off in this disease, according to the research team, and is one of the most important discoveries in the field since the 1960s. The finding marks the culmination of years of intensive investigation by faculty members in the medical school's Department of Neurology.
It was reported in the June 27 issue of the journal Science.The newly identified gene is involved in the production of a protein called alpha-synuclein. This particular mutation occurs in a single base pair, one of more than 400 letters in a chain that forms the blueprint for the protein. Scientists must now study the function of alpha-synuclein in the normal brain before understanding how the mutant version causes the disease.
They believe that fragments of alpha-synuclein bind to other proteins to form the Lewy body, an insoluble proteinaceous material characteristic of Parkinson's disease that is found inside the nerve cell.
"It's a little bit like throwing a wad of chewing gum into a motor," comments William Johnson, MD, professor of neurology and director of the school's William Dow Lovett Laboratory of Molecular Neurogenetics.
He says fragments of damaged alpha-synuclein have also been found in the amyloid plaques that characterize Alzheimer's disease, suggesting that a similar mechanism may be operating in both illnesses.
Parkinson's disease is a neurological disorder affecting 2 percent of the U.S. population. The average age of onset is 60, but 5 percent experience their first symptoms before age 40.
Progressive destruction of nerve cells in the region of the brain controlling movement results in a shortage of a brain-signaling chemical called dopamine. L-dopa - the standard medication for the condition - ameliorates the symptoms by replacing some of the brain's dopamine, but loses efficacy over time as more and more cells die.
In October 1996, this research group first identified the general site of the abnormal gene as the long arm of chromosome 4, and reported the finding in the November 15 issue of Science. They predicted at that time that in six months to two years, they would be able to determine the precise mutation.
The gene's discovery grew out of the group's unwavering belief that Parkinson's has an important genetic component. Their earlier epidemiological surveys and studies of twins proved inconclusive. In 1980, Roger Duvoisin, MD, William Dow Lovett Professor Emeritus in the neurology department and one of the developers of L-Dopa in the 1960s, began studying patterns of inheritance in familial clusters of this disease.
Working with Lawrence I. Golbe, MD, associate professor of neurology, Margery H. Mark, MD, associate professor of neurology, and Johnson, he identified a number of multi-case families. Johnson collected DNA from them and initiated a search for a DNA marker linked to the disease.
One family of Italian origin, identified 10 years ago by Golbe in the medical school's neurology clinic, was eventually found to comprise more than 400 individuals. So far, at least 60 cases of Parkinson's disease have been identified in the last five generations of this family - some of them through autopsy.
With the aid of colleagues at the University of Naples, Italy, Golbe was able to trace the ancestry of the family - through 12 generations - to an ancestral couple who lived in the village of Contursi in southern Italy in the early 18th century. His work confirmed that the family disease was in fact Parkinson's and showed for the first time that this disease could occur on a genetic basis.
Meanwhile, Alice Lazzarini, PhD, assistant professor of clinical neurology and director of clinical genetics at the school, studied familial aggregation in Duvoisin's private patients and established that a large subset of Parkinson's cases are familial. Her analysis of 80 multi-case families defined their pattern of inheritance as autosomal dominant, which means 50 percent of the offspring of a Parkinson's disease patient are at risk of developing the illness.
In October 1995, the medical school group began a collaborative effort with Robert Nussbaum, MD, and Mihael Polymeropoulos, MD, at the National Center for Human Genome Research, to locate the gene mutation in the Contursi kindred. "The NIH dedicated a lot of people, equipment, time and money to this project during the last 18 months, allowing for very rapid progress," Johnson says.
In less than a year, the research team linked the disease to DNA markers for a small region of chromosome 4. That discovery confirmed that Parkinson's can occur on a genetic basis.
The discovery of the gene will not immediately yield a diagnostic test for the general public, Lazzarini says. "Presymptomatic testing, or testing someone prior to the development of symptoms, will be limited to members of a family with a known mutation."
In our experience, most patients with inherited disorders do not know details about the medical history of past generations of their family, Lazzarini says. "With Parkinson's patients who do have that information, 50 percent reported another affected relative."
During the next year, Parkinson's families worldwide will be studied by the scientists to determine how many of them have this particular gene mutation. The researchers have found it in three individuals in Greece with familial Parkinson's who participated in this study; none of the other 53 patients, outside of the Contursi family, have been found to have the mutation.
"We will try to elucidate the mechanism of how this abnormal protein causes disease," Johnson comments. The group predicts that within five years researchers will begin testing therapies. Research will also focus on finding other genes that may work in concert with this one to produce the illness.
"Parkinson's has been a strikingly under-funded disease,"
Golbe concludes. "Our understanding of it is primitive compared with
AIDS, for instance. Perhaps this finding will spur interest in the illness,
which is sure to become even more common as the baby boomers continue their
climb toward 60."
Blame the Mouse
You can significantly reduce your risk of Lyme disease by learning to recognize and avoid the habitats of white-footed mice - the single greatest carrier of infectious ticks. So says a study directed by Steven Schutzer, MD, a Lyme disease specialist at UMDNJ-New Jersey Medical School. It was published in the June 7 issue of Lancet.
The researchers found that ticks were 23 times more likely to be found in habitats favorable for these mice, areas with dense vegetation that rises above the ankles, where bare ground can not be seen.
"There are two common misconceptions about Lyme disease: that deer are the primary carriers of infectious ticks and that the only place to contract Lyme disease is in heavily wooded areas," says Schutzer, who is also an associate professor of medicine at the Newark medical school. "In fact, ticks are plentiful in grassy and wooded areas, and are commonly found in the suburbs - on property surrounding homes and on golf courses."
Schutzer also warns that the same ticks that carry the Lyme disease agent can harbor microbes that cause Erlichiosis and Babesiosis - two diseases that are potentially fatal unless they are diagnosed and treated early. Current recommendations to wear long pants and long-sleeved shirts outdoors and to tuck pants into socks are rarely followed.
"You can significantly reduce your risk of exposure by avoiding wooded and grassy areas where white-footed mice thrive," he advises.
Bart Holland, PhD, associate professor in the Department of Preventive and Community Medicine at the medical school, did the statistical analysis for the project. Tom Brown, Jr., of the Tracking, Nature and Wilderness Survival School in Asbury, worked with his staff to identify and section off 100 square foot areas they determined to be highly suitable for mice because of the dense vegetation. They proved mice had been in those areas - and not in less dense ones - by identifying hairs, track imprints, chew marks, etc. The team collected ticks using magnifying glasses and tweezers.
The number of Lyme disease cases has been rising according to the Centers for Disease Control and Prevention. Reducing the risk of exposure by avoiding infested areas is the key to preventing the infection, Schutzer concludes.
But if you think you've been exposed and develop a rash, flu-like symptoms,
headaches, stiff neck, or muscle and joint pains, seek medical attention
quickly. Antibiotics are generally effective in treating the infection
when it is diagnosed early.
Getting Pumped Up
Chances are if you've been in a health food store lately you've seen the wide array of bottles on the creatine shelf. There are at least 15 brands of powder and tablets, and it also comes in the form of a candy snack. It's a bit pricey - a month's supply costs about $42 - but that hasn't deterred bodybuilders and athletes from buying it.
That's because the supplement, available since 1993, has taken off. It is now the thing to take for increasing muscle mass and boosting energy levels for longer workouts. A study done by the NCAA showed that 13 percent of all intercollegiate athletes took creatine in 1997. It is especially favored by those who do sports that require short, intense bursts of energy, like power lifting, martial arts and track and field. Sales have skyrocketed in the past two years.
Eugene Lucente, owner of Nature's Good Food and Vitamins in Verona, believes that's because it really does what it claims. "I've watched one man's muscles gradually increase in size after he started using it," he says. "Each time he came in to buy it, he was bigger."
Exactly how does creatine perform its magic? A chemical composed of methylguanidine-acetic acid, it is found in the skeletal muscles of the body and in trace amounts in the liver, kidneys and pancreas. Creatine works in conjunction with ATP (adenosine triphosphate), the chemical the body uses to produce energy for physical activity. Energy is provided when one of the phosphate molecules in ATP breaks off. ATP then becomes ADP (adenosine diphosphate). In order to create more energy, more ATP must be produced. This is when creatine phosphate goes into action. It gives up one of its phosphate molecules to the ADP, thus recreating ATP.
"The theory is that the more creatine you have, the more energy you produce," says Joseph Laccitelli, a fellow of the International Academy of Nutrition and Preventive Medicine and a medical nutrition consultant at the Verona store. "That means a longer workout, which builds strength and muscle size."
It's also believed, he notes, that the supplement acts as a buffer in muscle cells to decrease lactic acid build-up. A byproduct of exercise, lactic acid causes muscle fatigue and it's responsible for the burning sensation felt during an intense workout.
Creatine is taken in two phases, Laccitelli explains. During the "loading phase," the consumer takes five to six grams, six times a day for about a week. After that, in the maintenance phase, he takes between 12 and 20 grams a day - depending on body weight - for about a month.
As far as scientific proof that creatine does what it claims, Kathryn Lambert, DO, director of sports medicine at UMDNJ-School of Osteopathic Medicine, says there are well-designed studies that show it does and it doesn't.
The European Journal of Applied Physiology reported in March 1995 that individuals who took creatine demonstrated a significant increase in muscle performance and endurance.
Another study reported in the International Journal of Sports Nutrition in June 1995 on creatine and its application, however, showed no increase in muscle performance or endurance after taking the supplement.
Lambert says the results may vary because there is a huge difference in the baseline amounts of naturally occurring creatine in the body. When the skeletal muscles of 100 normal people were studied, the range was found to be from 90 to 160 millimoles per kilogram of dry muscle. "That's a tremendous normal range," Lambert notes."It makes doing studies difficult."
To date, the supplement has not been deemed unsafe in terms of side effects. "There have been anecdotal reports of muscle cramps," the physician says, "but no other serious side effects have been verified." Laccitelli and Lucente say only a few customers have complained of diarrhea and upset stomachs during the loading phase. "All the studies reported so far have been done over a three- to four-week period," Lambert points out. "We don't know what would happen if a person took creatine longer than that."
She does have a concern about the purity of the supplement. Since the
production of creatine is not regulated by the FDA, Lambert says there
is a possibility it could contain impurities. She recommends learning as
much as possible about a supplement before buying it, and getting to know
health food store owners and workers. Those who are more knowledgeable,
she says, will be happy to give you important information on a product
before you make a purchase.
Anyone who has ever suffered from plantar's warts knows how debilitating they can be. And, until recently, the unsightly growths could be very difficult to remove.
That's why James C. Ricketti, DPM, became particularly interested in a product he saw at a trade show in 1995. It was a freezing mixture, dimethyl ether, that had been imported from Holland. It had been used there successfully by Dutch physicians for years to remove warts on fingers, but had never been used in America. The importer didn't know how it worked.
Ricketti, a mentor for the surgical First Assistant Program at UMDNJ's School of Health Related Professions, says he took the cryogen to his office and "played with it," eventually developing a cryosurgical technique for the removal of plantar's warts. His methodology has since been patented and is now used throughout the United States and in 47 other countries.
The procedure involves freezing the wart for about 40 seconds, then applying salicylic acid, a topical agent that kills the virus. The number of treatments, Ricketti says, depends on the size and location of the lesion.
"Warts are about 89 percent water," he explains. "When you freeze them they expand, as water does, and the cell walls explode. The broken cells mix with material around them, and are sloughed off."
The podiatrist says the procedure is no more painful than holding an ice cube on the skin for a few seconds. The temperature of the mixture, called Histofreeze, is not low enough to cause permanent tissue damage, and there is no scarring. Nearly 70 percent of those treated for warts on the feet report no recurrence. "Considering that one in every four Americans will develop a wart this year, those are pretty good odds."
Ricketti has also revived a technique used in the 1940s that involves the use of phenol, a derivative of benzene. It made its medical debut in Philadelphia in 1945 when podiatrist Otto Boll presented a new method for permanently removing ingrown toenails: The portion of the embedded toenail was cut away and phenol alcohol was applied to the underlying tissue for 60 seconds. The chemical burned out the growth plate, permanently stunting the future growth of that portion of the nail.
But in 1993 the government announced that it was illegal to transport the highly flammable, hazardous chemical. Podiatrists were dumbstruck. "It was the standard method. Everyone used it," Ricketti says. "We were really upset."
Not long after that, Ricketti says, he got an idea in the middle of
the night. He thought, "Why not put the phenol on a small, cotton-tipped
swab and seal it in a foil package?" He developed his idea, found
a manufacturer and to the delight of podiatrists everywhere Phenol E-Z
Swabs were born and patented.
Foiling Heart Failure
Treating older people who have high systolic blood pressure with a low-dose diuretic reduced their chances of developing heart failure by 50 percent. Those who had already had a heart attack did even better - their rate dropped by 80 percent.
These findings, the result of a multi-site, nationwide study called the Systolic Hypertension in the Elderly Program, were reported in the July 16 issue of the Journal of the American Medical Association. John B. Kostis, MD, chairman of the Department of Medicine at UMDNJ-Robert Wood Johnson Medical School, is the lead author.
He and his colleagues tracked 4,736 men and women age 60 or older for an average of 4.5 years; 492 of them had a heart attack prior to the start of the study. They all had a systolic or upper blood pressure reading between 160 and 219 and a diastolic or lower pressure of under 90. Persistent readings above 140/90 are considered abnormal.
Patients were randomly assigned to receive either a placebo or a low dose of the diuretic, chlorthalidone. If the drug did not control the blood pressure, Kostis says, a second drug - usually atenolol - was also given. About one third of the entire group required a second drug.
Heart failure affects about 4.8 million Americans, 3.4 million who are 60 or older. There are about 400,000 new cases each year, and half of those with heart failure die within five years of diagnosis.
Kostis notes: "We hope this study will encourage more patients who have hypertension to seek treatment to prevent the onset of heart failure."
The project was sponsored by the NIH's National Heart, Lung, and Blood
Institute and the National Institute on Aging.
Change of Heart
If you've just come through major heart surgery, or survived an almost fatal heart attack, you might just be feeling on top of the world - at least for a week or two. But then you look in the mirror and you're still 35 pounds overweight, your muscles sag, and your blood pressure pounds higher and higher with each call from your boss asking when you'll be back. You flop down on the couch with a cup of coffee and a doughnut, worrying about what to do, when a thought jumps into your head - you're back in the same old groove that landed you in this mess in the first place.
About 1.5 million Americans have heart attacks each year - one third are fatal. For the one million who survive, the experience is often a wake-up call. An additional 12 million or more Americans have some form of coronary heart disease.
"It's very hard to change a lifetime of risk factors for heart disease," notes Robert Egermayer, a cardiac physical therapist. Those that can be changed include obesity, smoking, high blood pressure, high blood cholesterol, sedentary lifestyle, diabetes and stress.
But when the alarm goes off, can a change of heart translate into a change of body?
"Yes," says Egermayer, who works at UMDNJ-University Hospital's cardiac rehabilitation program. "But most people can't do it alone. They need information, structure and help to develop new routines."
The physical therapist's "office" is a fitness addict's wildest dream, stocked with the latest exercise equipment, computer monitors and fitness and diet information. "Give me three months," he says, "and we'll give you the tools to reshape yourself for a lifetime."
Not a bad offer! But how do you start?
"Many people who walk in here are embarrassed because they know so little about exercise," says Egermayer. "Others are fearful that strenuous exercise may bring on more heart problems."
But, he says, a cardiac rehab program is designed even for those who've never stepped on a treadmill or lifted a weight, who don't have a clue how to monitor their own heart rate, and especially for those whose dietary preferences run to cheeseburgers and fries rather than salad and brown rice.
Cardiac rehabilitation includes an individualized regimen of regular aerobic exercise and strength training, as well as a risk factor intervention program to help reduce stress, weight, blood pressure and cholesterol. It has been shown to diminish the risk of morbidity and mortality associated with heart disease, to control cardiac symptoms, and to stabilize the progression of atherosclerosis. Even so, less than 20 percent of those who could benefit are currently taking advantage of such programs.
According to Egermayer, the approach involves learning more about the heart, how it functions and what impacts on its health, because most of us know little beyond depictions of its failings in love songs and poems. Personal instruction in the use of exercise equipment, employing EKG monitoring to measure individual limitations, learning to recognize the heart's signs and signals of distress, and determining how to gradually extend the exercise routines are central to the program. The ultimate goal is for the individual to incorporate these exercises and lifestyle changes into his normal daily habits.
"Knowing you have a serious heart condition is often very stressful," the physical therapist notes. "Learning how to take control of the risk factors not only lessens the chances of future heart problems, but can relieve some of the stress and fear, and help you recover far more quickly."
For further information about cardiac rehabilitation,
Stress and ulcers are still a ready marriage in people's minds, even after a decade of research linking peptic ulcers with H. pylori infection. It is estimated that one billion individuals worldwide harbor the bacterium, although many do not develop ulcers.
But what about kids? Does H. pylori make its way around a household in much the same way as an intestinal virus? According to Francis Sunaryo, MD, assistant professor of clinical pediatrics at UMDNJ-New Jersey Medical School, if one parent is infected, the likelihood is high that both the spouse and children also will be. This is particularly true in countries or communities where the standard of living is poor.
The infection is usually acquired in childhood and is most often transmitted by the fecal-oral route. The bacteria have also been isolated from saliva and dental plaque.
So when Jr. complains of stomach aches every night after dinner, is H. pylori the likely culprit? No, says Sunaryo, who is a specialist in pediatric gastroenterology: "Recurrent abdominal pain in children is not generally a symptom of peptic ulcer." If, however, the pain is associated with nighttime awakening, recurrent vomiting and a family history of ulcers, it is likely the child is suffering from peptic ulcer.
A study conducted in Vancouver and published in Digestive Diseases and Sciences in 1991 showed 85 percent of children with ulcers in the uppermost part of the small intestine (duodenum) were infected with H. pylori.
A blood test used to diagnose the infection is widely available but not entirely reliable because the results do not always indicate the presence or absence of ulcers and continue to be positive for years after the bacteria have been eradicated. Examination of a tissue sample - taken with endoscopy and studied microscopically - is still the best way to diagnose peptic ulcer and H. pylori infection, says Sunaryo, although it is invasive and more expensive. Breath tests - which will most likely be made available soon for children - will be used to prove eradication of infection after treatment.
For children with peptic ulcers and H. pylori infection, a two-week course of treatment with a combination of antibiotics such as clarithromycin and metronidazole, and a proton pump inhibitor usually eradicates the infection and alleviates the symptoms. Reinfection generally does not occur.
H. pylori in adults has been linked to gastric cancer and lymphoma. The World Health Organization has recently classified H. pylori as a group 1 carcinogen, putting it in the same category as cigarettes and their link to lung cancer. Infected individuals have six times the rate of gastric cancer as non-infected individuals.
So, should the bacteria be eradicated as a means of prevention? The
recommendation by the National Institutes of Health's Consensus Development
Panel in 1994 is to treat only infected individuals with peptic ulcer.
It is not recommended to treat the infection if there is no evidence of
peptic ulcer. Sunaryo says future large-scale clinical trials or decision
analyses will help answer this important question.
In Good Company
In the fall 1995 issue of HealthState, we profiled two scientists who were in a precarious position. Drs. Raphael J. Mannino and Susan Gould-Fogerite at UMDNJ-New Jersey Medical School had developed a novel system for delivering therapies - drugs, vaccines, genes - and were ready to begin testing it in human trials.
Although this work had been funded by the National Institutes of Health for more than 10 years, studies directed toward human trials are not sponsored by traditional NIH basic research grants. The scientists needed to form a company and get financial backing in order to keep their core group together and take the next step. And they did.
For business expertise, they turned to Irving A. Berstein, PhD, who had started up three medical technology companies that were eventually acquired by major corporations. For 14 years he was associated with M.I.T. and Harvard Medical School's joint division of health sciences and technology. Berstein was impressed with the scientists' innovation - a jelly roll-shaped cochleate whose outer lipid coating protects the inner layers of therapies from being degraded by stomach acids. BioDelivery Sciences, Inc. (BDS) was formed in March 1995, with Berstein as chairman of the board, Mannino as president and chief scientific officer, and Gould-Fogerite as vice president.
She says the company's licensing and research agreements have made it profitable from the start. One signed in June 1996 with Wyeth-Lederle Vaccines and Pediatrics, a division of American Home Products, provides BDS with up to $15 million for research and development over several years. In return, Wyeth-Lederle gets exclusive licensing rights for the technology used for human vaccines.
This is a good deal for the University, too. Besides having equity in the company, it shares in income from licensing agreements, royalties on products and gets overhead from grants awarded to the researchers.
"The last time we talked to HealthState we were on the edge," says Gould-Fogerite. "'Staying Alive' was an appropriate title for the article. Now it's a matter of where we concentrate our efforts. We have a lot of work in vaccines and we're investigating drug delivery and gene therapy. The preliminary data is encouraging."
Their cochleate system allows for oral, nasal and - in some cases - ocular delivery of vaccine formulations. The DNA vaccines encode for specific proteins. Once they are expressed, the immune system makes antibodies and cell-mediated responses to them. Using DNA rather than killed or attenuated virus to produce immunity is particularly advantageous in people who are immune compromised. Mannino and Gould-Fogerite hold two patents on their delivery systems, two are about to issue and several are pending.
Two members of the research group are alumni of the UMDNJ-Graduate School of Biomedical Sciences. Alan Mautone, who is director of delivery technologies research, has a doctorate in physiology and has worked on aerosolized lipid-based drug delivery systems for 10 years. Dan Brois, the company's assistant director of gene therapy applications, earned his PhD in pathology and has expertise in both molecular and cellular biology.
BDS has offices in Lexington, Mass., where Berstein is located, and
in France, but the research facility is still at UMDNJ. Mannino and Gould-Fogerite
are setting up shop in those "eternal" interims - the blue
buildings on Bergen Street that housed New Jersey Medical School when it
relocated to Newark in 1967.
Surgery often causes grave blood loss. So do most serious accidents. Since the 1930s, when the first blood banks were founded, replacing lost blood has often been equated with saving lives.
So why is there currently such an interest in bloodless surgery?
About two thirds of patients who refuse blood are Jehovah's Witnesses, whose religious beliefs - based on several biblical passages which speak of "abstaining from blood" - unequivocally rule out blood transfusion. There are as many as 6,000 members of the religion in Newark and 70,000 statewide. The other third consists primarily of health care workers.
Michelle Thomas, a nurse clinician for the one-year-old Center for Bloodless Surgery and Medicine at UMDNJ-University Hospital in Newark, says a number of approved pharmaceutical agents can be used to lessen or prevent anemia. Among them are erythropoieten and iron, which stimulate the bone marrow's production of red blood cells.
There are also several techniques currently in use that minimize the need for blood transfusions. One, known as cell-washing, recycles blood that is lost during surgery. For example, blood spilled into the abdominal or chest cavity is collected, filtered and reinfused in a continuous process. Another technique known as hemodilution begins before surgery. Blood is drawn from the patient and replaced with intravenous fluids; any blood that is lost during the surgery has been diluted, therefore not as many red blood cells are lost. Blood drawn prior to surgery is given back to the patient during the operation.
In the practice of bloodless surgery - which includes pediatrics, oncology, OB/GYN and brain surgery, in addition to general surgery - a slow, meticulous approach and choice of instrumentation become crucial, according to Edwin A. Deitch, MD, chairman of the Department of Surgery and medical director of the center. He says that in many cases clamps, electrocautery and burning instruments, surgical lasers, and argon beam coagulators might be utilized in place of scalpels and scissors, because these traditional instruments result in a greater loss of blood. The downside is that this approach takes a lot more time.
Thomas says that she is on call at all times to meet patients when they are admitted to the hospital. At that time, she and the patients create an advanced directive, or living will, which clearly documents the patients' wishes, and they review the center's release of liability agreement, which frees the hospital from any responsibility for personal injury related to their refusal of blood.
The nurse, who is also a Jehovah's Witness, explains: "This is a legal issue because it is considered an assault to give someone treatment which is clearly refused in that person's advanced directive." During the length of hospitalization, patients are identified by a bright red identification wrist-band which states "No Blood."
While Jehovah's Witnesses flatly refuse transfusion of whole blood, packed red cells, white blood cells, plasma and platelets, their religion does not prohibit the infusion of minor blood fractions such as albumin, clotting factors and immune globulins.
Health care workers often bank their own blood if they are anticipating elective surgery, Thomas says: "They fear contracting an infection from a transfusion. Although blood from a bank is thoroughly tested, there are infections just being discovered for which there are not yet any tests. And there is still the rare case of HIV transmitted via a blood transfusion." Health care workers also know that blood transfusion suppresses the immune system, thereby prolonging or complicating the healing process, she explains.
"Not all blood transfusions which were once thought to be needed are medically indicated," concludes Deitch. "An unnecessary blood transfusion involves risk which the patient does not have to take."
For further information about bloodless surgery and medicine, call: 1-800-BLD-LESS.
Fall 1997 Table of Contents