Frequently Asked Questions

What services are offered? [TOP]

The ATP Center is comprised of physicians from multiple disciplines who are willing to provide care without the use of blood or blood products. Please call the ATP Center Hotline at 1-877-474-8558 or 410-502-7359 to speak with the nurse program coordinator, who will be able to explain to you in detail, based on your individual needs, the services that are offered.

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How do I make an appointment? [TOP]

Patients can make an appointment by calling the ATP Center Hotline at 877-474-8558 or 410-502-7359.

Patients will be asked the following information at this time:

• An explanation of the current medical problem for which you wish to come to Hopkins
• Your current physician's name, address and phone number
• Your insurance information

You may be asked to have your current medical record faxed to us for review by our physicians.

Physicians may refer patients via the ATP Center Hotline or by calling the Hopkins Access Line (for physicians only) at 1-800-765-JHHS (5447) or 410-955-9444. The HAL line is open 24 hours a day, 365 days a year.

International visitors can access the Hopkins International Services department, staffed with interpreters and patient coordinators who can help with the planning, duration and discharge of your appointment(s). They can be reached at 410-955-8032 or toll-free within the United States at 1 undefined 800-603-4898.

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What is hemodilution? [TOP]

Hemodilution is a process used just before surgery. Using a closed system that maintains continuous contact with your circulation, a physician will remove one to four pints of your own blood while replacing it in your body with salt water via an IV. The surgeon is able to do the operation normally, without the need of blood transfusions. Then, at the end of the operation, this blood is given back to you to replace the blood and salt water you lost during the procedure. For Jehovah's Witnesses, this procedure is considered a matter of conscience.

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What are blood fractions? [TOP]

It is one part of the substances that make up blood! There are major and minor blood fractions. Major blood fractions include red blood cells, white blood cells, plasma and platelets. Minor blood fractions include: albumin, gamma globulin, cryoprecipitate and fibrinogen. A blood transfusion or a medication that contains albumin or one of the other fractions listed are considered to contain a blood fraction. For Jehovah's Witnesses, major blood fractions are not accepted. Medications containing minor blood fractions are considered to be a matter of conscience.

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What medications contain blood fractions? [TOP]

Products that may have been processed with or contain small amounts of albumin include:

• Streptokinase, erythropoietin, cryoprecipitate, synthesized clotting factors and some radionuclide scan preparations
• Immunoglobulins such as RH immune globulin, gammaglobulin, horse serum and snake bite antivenins
• Clotting factors such as fibrinogen, Factors VII, VIII, IX and XII.

These medications are considered a matter of conscience for Jehovah's Witnesses.

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What does "recombinant lab techniques" mean? [TOP]

It means it was made in a laboratory.

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What is bloodless medicine/surgery? [TOP]

Bloodless medicine and surgery is the practice of medicine and surgery without the use of donor blood or blood products.

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What alternatives are available to avoid blood products at Hopkins? [TOP]

Currently at the Johns Hopkins Hospital, the following alternatives to blood products are available:

Medications: erythropoietin (epogen), IV iron, antifibrinolytic agents, fibrin sealants

Perioperative techniques:
Pre-op: Use of epogen to boost the patient's hemoglobin and red blood cell count in anticipation of blood loss during surgery
Intraoperative: Meticulous surgical technique, hemodilution and cell salvage
Post-op: Selected and restricted blood drawing, tolerance of anemia, epogen

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Is this program being started due to the decline in the blood supply? [TOP]

There are many reasons why this program was started. They include: blood supply issues, recognizing patient autonomy and a patient's right to make decisions about their care, and research that indicates that avoidance of blood may lead to better patient outcomes.

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How much experience does Hopkins have in bloodless medicine/surgery? [TOP]

Hopkins physicians have participated in caring for patients who request no blood products for many years. We are now just formalizing this existing effort into a center where the primary goal is concentrating all efforts into providing care without blood products and discovering new ways to do it.

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How have doctors at The Johns Hopkins Hospital developed expertise in advanced transfusion practices? [TOP]

This has been achieved in multiple ways, including: an extensive medical training program, peer review, medical courses, and clinical research in proving the safety and efficacy of techniques used in advanced transfusion practices.

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What is The Johns Hopkins Hospital policy guaranteeing the patient the right to refuse a blood product? [TOP]

The law of informed consent is based on the premise that a patient has the right to receive sufficient information to make an informed choice about the treatment recommended and then choose to accept or decline the physician's recommendation. It is the policy of the institution to comply with the wishes of a competent adult patient regarding the administration of blood and blood products. The patient is required to sign a Johns Hopkins Hospital Refusal of Blood and Blood Products Form for Adult Patients.

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What are the rights of minors in the area of bloodless medicine/surgery? [TOP]

A parent or guardian may not withhold blood or blood products from a minor in a life-threatening situation. If the parent or guardian refuses blood or blood products for the minor, the responsible physician will obtain the appropriate court order for legal consent. In an emergency situation where judicial assistance cannot be obtained in a timely manner, the physician may administer medically indicated blood or blood products.

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How can I learn more about your program? [TOP]

There are many sections in this Web site with general information about our program. To name a few, look into the buttons in the Patient section called "Patient Information" and "The Bloodless Medicine and Surgery Program at Johns Hopkins." The Glossary section should prove helpful in defining words used throughout the Web site. You may call the ATP Clinical Center to speak with the nurse program coordinator, who will be glad to discuss any questions you have, or mail you a patient brochure: 410-502-7359 or 1-877-474-8558.

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What are the risks of blood transfusions? [TOP]

Risks of tranfusions include:

• Transfusion reactions
• Alloimmunization
• Disease transmission
• Potential for immune suppression leading to an increased chance of wound infection for surgical patients

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May a doctor refuse to treat a patient who will not take a blood product? [TOP]

Physicians may have ethical concerns with not providing the maximal amount of medical interventions they feel necessary to take care of the patient. In these situations, the physician has the ethical responsibility to transfer the patient to a physician who is willing to cooperate with the patient's wishes.

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Besides religious reasons, why would a person refuse a blood transfusion? [TOP]

There are several reasons:

• Personal preference
• The belief that transfusion is not necessary
• Fear of the safety of donor blood

 

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