[Bloodless medicine].

The origin of bloodless medicine was probably generated due to the religious impediment of Jehovah's witnesses. In 1988 in Brooklyn New York, U.S., a hospital information center was created help Jehovah's witnesses 24 h/7 days a week. There are 109 branches of these centers in 230 countries throughout the world. Some Jehovah's witnesses may accept blood derivatives such as immunoglobulin, interferons, topical hemostatic cements, or auto-transfusion techniques. At present, there are a substantial number of bloodless surgery procedures including cardiac and orthopedic procedures, and there are 75 hospitals functioning in the U.S. and 105 in additional countries including Italy, Canada, Switzerland, Chile, France, and Australia. For massive blood loss in Jehovah's witnesses, coordinated work among medical team members is mandatory. The effectiveness of the blood transfusion in the polytraumatized patient is well known. In catastrophic hemorrhage, hyperbaric oxygenations can be of help if sustained as long as necessary to give time for the action of compensatory mechanisms. Nonetheless, transfusion of blood components is needed in surgical cases such as those involving liver, heart, and bone marrow transplantation, as well as in regenerative anemia or thrombocytopenia. Bloodless medicine costs are lower, but there is no precise way to estimate the costs of resources and other concepts for the operation of bloodless medicine. Alternatives such as auto-donation prior to surgery or acute normovolemic hemodilution can be proposed to patients who reject allogenic blood transfusion.