The distinction of becoming the first program in the state to achieve accreditation from the Association for Blood Conservation, (formerly known as The National Association of Bloodless Medicine and Surgery) has solidified the reputation of The Center for Bloodless Medicine and Surgery at Hackensack University Medical Center as being on the forefront of providing medical and surgical care without the use of transfused blood products.

When the medical center earned this accolade in 1999, it was the first program in the state to meet the tough standards that had been developed by the Association for Blood Conservation, by which a bloodless program can be measured. The Center for Bloodless Medicine & Surgery was re-accredited in 2006 (click here for details).

Click on a topic below for specific program information.



Mission of the Bloodless Medicine and Surgery Program
What is Bloodless Medicine and Surgery?
The Advent of Bloodless Medicine — Responding to Community Needs
Your Rights are Protected by Law
The Medical Directive — Your Wish is Our Command
A New Mindset for Physicians — Revised Protocols for Treating Anemia
The Medical Center's Approach — Your Personal Nurse Manager
Assuring Your Blood-Free Choice — Methods for Patient Identification
Transfusion-Free Techniques and Strategies
Program Registration


Mission of the Bloodless Medicine and Surgery Program
The most complex surgeries and intricate procedures have been successfully performed at the medical center using bloodless medicine techniques and strategies. Our dedicated and experienced team of healthcare professionals respect the convictions of all the patients who request these services. The mission of the Center for Bloodless Medicine and Surgery is clear — to ensure that the dignity and legal rights of patients, especially the right to informed consent, are respected.

What is Bloodless Medicine and Surgery?
The Bloodless Medicine and Surgery program is a focused commitment to provide medical care and surgical procedures without the use of stored blood products. This outcome is achieved using the following fundamental strategies:

• plan ahead to fully integrate bloodless strategies into a patient’s treatment plan
• increase a patient’s red blood cell count prior to surgery
• minimize blood loss from laboratory testing by microsampling
• prevent the loss of blood during surgery by using the most advanced instruments, and
• collect the blood lost during and after surgery and recycle it back into the patient.

(Click Transfusion-Free Techniques for detailed information.)

The Advent of Bloodless Medicine — Responding to Community Needs
The Center for Bloodless Medicine and Surgery was created in response to the needs of our patients who reject the concept of receiving donated blood. Some individuals refuse transfusions due to religious beliefs. And although the Food and Drug Administration has deemed the blood supply safe, there are those who believe that transfusions will always carry some risk of blood-borne infections and immune system suppression.

Whatever your reason for seeking medical care using bloodless medicine techniques, you can rest assured that the staff at The Center for Bloodless Medicine and Surgery will adhere to your wishes and respect your convictions.

Your Rights are Protected by Law
A patient’s right to refuse a blood transfusion is protected under the Federal Self-Determination Act of 1991, whereby:

• an adult patient is guaranteed the right to bodily self-determination and
• written consent must be given for all procedures.
  This is called an informed consent, which means that you must have all procedures explained in layman’s terms that you understand and comprehend.

This law protects your choice to refuse what sometimes is life saving treatment once your physician explains the risks, benefits and alternatives.

What about Children? The medical center's Department of Pediatrics wholeheartedly supports bloodless medicine technology, and specialists from all disciplines have joined forces with the Center staff to provide this care. Although minors and their guardians do not have the lawful right to refuse life-saving treatment, children who are registered in The Center for Bloodless Medicine and Surgery may take advantage of all the same transfusion-free techniques and strategies that are offered to adults. These bloodless medicine practices significantly reduce their chances of needing blood products during their care.

The Medical Directive — Your Wish is Our Command
An Instructive Directive and Health Care Proxy, most often referred to as a medical directive or proxy, gives you the absolute legal right to informed consent, meaning that you can choose or refuse medical treatments that have been explained to you by your doctor. This includes the right to refuse the use of blood once your physician has explained the risks, benefits and alternatives. It also protects the physician from liability since the document is your sworn statement that you are aware of the risks of refusing possible life-saving treatment. The information included in the directive includes not only what you refuse, but also what alternatives to blood and related technologies, such as cell saver that you will conscientiously accept.

If you have not filled out your medical directive, feel free to call our office to set up an appointment. We will assist you in completing this legal document, explain your rights in simple terms, keep one copy on file and give you free copies for your personal use.

How do I request transfusion-free care in an emergency situation? If you should ever need emergency care at Hackensack University Medical Center, a verbal request for bloodless medicine practices will be understood by the ER staff since they have been trained to respond accordingly. However, just in case you are involved in an accident that would prevent you from speaking, make sure that your family and friends know of your wishes and that you always carry your medical directive card.

If you already are registered at the Center for Bloodless Medicine and Surgery, your medical directive will be held on file at the medical center and can be accessed in any emergency situation by stating your wishes to ER personnel. A Nurse Manager is available around the clock, seven days a week to assist you in matters relating to your transfusion-free care. The office number is 201-996-2963. The 24-hour pager number is 201-495-5818.

A New Mindset for Physicians — Revised Protocols for Treating Anemia
The emergence of bloodless medicine as a new medical discipline reflects the current medical philosophy that patients can survive much lower blood counts than traditionally thought. Physicians now have a clearer understanding of anemia, which is the basic underlying medical condition that often necessitates a blood transfusion.

What is Anemia? Anemia is a low red blood cell count. Red blood cells are the blood component that carry oxygen throughout the body. Since oxygen keeps your cells alive and functioning, a sufficient supply of red blood cells is vital to staying alive. The diagnostic test for anemia is the measurement of hemoglobin (hgb), which is the main component of red blood cells.

New Anemia Protocols
Until recently, the trigger point for the diagnosis of anemia — or the measurement that prompted most physicians to recommend a transfusion — was a hemoglobin of 10. Revised medical protocols have lowered the transfusion trigger to a count of seven.

Rather than just looking at the numbers, though, the medical team at The Center for Bloodless Medicine and Surgery watch for the symptoms as well. Each patient tolerates anemia differently, so a count of seven may be dangerous for one patient yet tolerated fairly well by another. Most recently, clinicians are realizing that there really is no absolute number at which a patient needs to be transfused.

These new anemia protocols, along with bloodless medicine techniques have contributed to the success of the medical center’s transfusion-free program. Transfusions can be safely avoided and a vast majority of patients — even those undergoing complex surgeries — can now take advantage of safe, transfusion-free treatment.

The Medical Center's Approach — Your Personal Nurse Manager
The Center for Bloodless Medicine and Surgery (CBMS) assigns each participant a nurse whose role as a Patient Advocate and Case Manager assures the full integration of bloodless medicine techniques and strategies into each treatment plan. The CBMS staff will do everything in their power to make sure that you receive safe bloodless treatment.

Personalized case management means the CBMS staff will guide you through a full continuum of bloodless care throughout your entire treatment, including: pre-admission during your hospital stay following discharge.

          Pre-Admission Activities:

• assist you with your medical directive, which is written documentation of your refusal for blood transfusions
• meet with you prior to your admission to assist in the selection of the appropriate physician(s) and make referrals to specialists, if needed
• consult with your physician(s) prior to admission if indicated to assure the full integration of bloodless medicine techniques and strategies into your treatment plan, and
• assure that you are properly identified on hospital records as a bloodless medicine patient.

          Activities During Your Hospital Stay:

• in addition to proper identification on all hospital records, arrange for highly visible methods for patient identification as a bloodless medicine patient
• visit you each regular business day and at other times as necessary, to monitor your care and follow your blood count and other laboratory test results, and
• facilitate the needs of the physicians on your case.

          Activities Upon Discharge:

• conduct discharge planning to assure that your needs are met once you return home and that strategies to rebuild your red blood cell count are part of your follow-up care.

A CBMS staff member is available around the clock, seven days a week to assist you in matters relating to your transfusion-free care. The office number is 201-996-2963. The 24-hour pager number is 201-495-5818.

Assuring Your Blood-Free Choice — Methods for Patient Identification

Each patient's chart is affixed with a "No Blood" sticker.	A prominent "No Blood" wristband is placed on each patient's wrist.

Our commitment to your choice for transfusion-free treatment begins before you are even admitted to the hospital and is visibly evident throughout your stay. A special identification system has been created to ensure that your transfusion-free care request is clearly identified to all staff members. These safeguards include:

• special "No-Blood" wristbands
• "No-Blood" bedside signs
• "No-Blood" stickers on the front of your chart.

A highly-visible sign is placed on
the wall above the patient's bed.

Transfusion-Free Techniques and Strategies
Bloodless medicine techniques are employed during several phases of your medical care and surgical treatment, as needed, including:

• Pre-Admission Strategies
• Operative Strategies
• Surgical Techniques
• Post-Surgical Techniques

Some of the more common bloodless medicine techniques employed at The Center for Bloodless Medicine and Surgery are listed below. If you have any questions about these procedures, you can contact 201-996-2963.

Pre-Admission Strategies:
When indicated your nurse manager will consult with your physician to plan strategies that will help you compensate for the expected loss of blood during surgery, such as:

Hematopoietic Agents — iron supplements and other medication can be given for several weeks prior to surgery to stimulate the production of red blood cells. These same agents can be used after surgery, if needed, to rebuild the red blood cell count.

Microsampling — the use of fewer samples and smaller amounts of blood for laboratory testing, which helps to keep your blood supply intact.

Pre-Operative Bone Marrow Stimulation — treatment of anemia with erythropoietin, a drug that boosts red blood cell production in the patient’s own bone marrow.

Operative Strategies:
Some of the more common operative strategies include:

Hemodilution — blood conservation employed during surgery whereby the patient’s circulatory system is diluted to minimize blood loss.

Volume Expanders — non-blood fluids that are used to enhance circulation.

Surgical Techniques:
During surgery, the amount of blood loss can be significantly reduced through a variety of approaches:

Blood salvaging (Cell Saver®) — the recovery of blood that spills in the chest or abdominal cavity during surgery or into drains after surgery. The blood is collected using a Cell Saver® machine, filtered and then re-infused back into the patient.


During surgery, a Cell Saver® machine
collects lost blood, which is then
filtered and re-infused back into
the patient.

Precise Techniques — extra caution and deliberate operative techniques, such as avoiding small cuts, immediate clamping and cauterizing of bleeding vessels, etc.


The Harmonic Scapel ® causes less
blood loss than traditional cutting
scalpels by sealing blood vessels.

Choice of Instruments — many types of surgical instruments now have features that help stop bleeding, such as surgical lasers, The Harmonic Scapel ®, electrocautery and argon beam coagulators, just to name a few. These instruments cause less blood loss than traditional cutting scalpels by sealing blood vessels, which helps in the clotting of blood during surgery.


The Argon Beam Coagulator helps
to stop bleeding during surgery.

Minimally Invasive Surgery — performing surgery through smaller incisions with the use of scopes for visualization.

Laparoscopic Surgery — surgery using small incisions to minimize blood loss.

Interventional Radiology — a technique to either open closed blood vessels or close off bleeding vessels through very small holes in the skin.

Post-Surgical Techniques:
Homeostatic Monitoring — the careful monitoring of blood pressure, temperature and fluids are essential in all surgical patients, but for the transfusion-free patient it helps to recognize the early warning signs of anemia so that alternative corrective strategies can be implemented as soon as possible

Homeostatic Agents — drugs that promote clotting of the blood.

Program Registration
For registration information, call The Center for Bloodless Medicine and Surgery at 201-996-2963. Patients may enter our program in a number of ways:

Patient Request
Any patient can call for an appointment with a Nurse Manager, who will meet with you to discuss your medical needs and recommend the appropriate specialists in the program.

Physician Referral
Upon referral from a physician, the Nurse Manager will help to plan and coordinate your bloodless care and will also explain all possible alternatives to blood transfusions.

Emergency Room
ER staff members are fully trained in providing appropriate treatment to those seeking bloodless care, and will, upon request, automatically call the Nurse Manager from The Center for Bloodless Medicine and Surgery who will consult with your physician(s)should you have a crisis.

Advance Directive
If a patient presents an advance (medical) directive for blood refusal when admitted to the hospital The Center for Bloodless Medicine and Surgery will be notified. If the advance directive is on file The Health Information Department or The Center for Bloodless Medicine and Surgery will retreive it upon request. Always ask for The Center for Bloodless Medicine and Surgery to be contacted about your admission The Center for Bloodless Medicine and Surgery is a free program for all participants.