2. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely. “DON’T LEAVE HOME WITHOUT IT!”

3. Save Blood. Save Lives. This presentation will cover: The importance of completing a durable healthcare power of attorney Procedures & Therapies used at McLeod Blood Conservation Services helping you choose wisely. Help you to complete your healthcaredurable power of attorney as needed Help you to complete your healthcare durable power of attorney as needed

4. Save Blood. Save Lives. The importance of a completed durable healthcare power of attorney Blood Conservation Services helping you choose wisely.

5. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely. Unbaptized publisher Bad reaction to medicine and was in a medically induced coma for one month No medical directive or living will Court ruled against husband who is a JW in favor of her parents so that she could receive a transfusion Case 1 in 2006

6. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely. Baptized publisher Ruptured ectopic pregnancy with significant blood loss Had completed medical directive While in severe pain, she stated that she refuses transfusion of whole blood or red blood cells but would accept platelets and plasma Hospital personnel accepted that statement as a reversal of her written wishes Case 2 in 2012

7. Save Blood. Save Lives. If you do not have an executed durable health care power of attorney, “The SC Adult Health Care Consent Act sets out the order of priority for selecting (substitute) decision-makers. The order is a follows: Blood Conservation Services helping you choose wisely. 1.Guardian appointed by the Court 2. Spouse (unless divorced, signed written agreement, or legally separated- 3.Parent or Adult Child (with equal priority) 4.Adult Sibling or Grandchild or Grandparent (with equal priority) 5.Any other relative (blood or marriage)

8. Save Blood. Save Lives. To make sure that your healthcare durable power of attorney is a legal document: Blood Conservation Services helping you choose wisely.

9. Save Blood. Save Lives. All 4 pages must be kept together; therefore do not cut or tear apart your DPA Blood Conservation Services helping you choose wisely. Fold and place in your wallet with the NO BLOOD logo clearly visible if possible Please remember that your healthcare agent CANNOT witness your DPA In SC: Your name, address and date signed and those of the witnesses must be complete including the zip code

10. In SC: Can be used for all non-JWs such as unbelieving spouses and adult children Must be notarized In NC: Slight difference from SC and must also be notarized

11. Save Blood. Save Lives. What are blood fractions? How are they used? Blood Conservation Services helping you choose wisely. Blood Fractions

12. Blood Conservation Services helping you choose wisely.

13. Save Blood. Save Lives. Red Blood Cells 40 -45% Plasma 55% White Blood Cells & Platelets 1% Whole Blood is spun through a device called a centrifuge. It becomes separated into four main parts. Blood Fractions – What are they? Blood Conservation Services helping you choose wisely.

14. Save Blood. Save Lives. Whole Blood and its Main Blood Components are not accepted by Level I patients. The separation into these components are the beginning of a process called [ Fraction ]alization Main Blood Components Red Blood Cells 40 -45% Plasma 55% White Blood Cells & Platelets 1% Blood Conservation Services helping you choose wisely.

15. Save Blood. Save Lives. Fractions from Plasma Blood Conservation Services helping you choose wisely. 7% ALBUMIN FIBRINOGEN GLOBULINS CLOTTING FACTORS 91% WATER Many blood fractions are derived from plasma. Through varying processes, plasma can also be broken down into proteins that include albumin, fibrinogen and globulin. Each one of these proteins can be used as treatment in various medical conditions.

16. Blood fractions from plasma are first heated up to 140 0 F (pasteurization) for 10 hours and then cooled to temperatures as low as 21 0 F. Then it is cooled between 21 - 26 o F Save Blood. Save Lives. Albumin Protein extracted from plasma. Makes up to 4% of plasma. Blood Conservation Services helping you choose wisely. Plasma is heated to 140 o F

17. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely. When blood is lost from the body, the first step is to stop the bleeding. The second step is to return the blood volume to the body. Albumin it added to an IV solution which aids in replacing the lost volume thereby allowing the remaining red blood cells to carry oxygen. Albumin is used as a volume expander to treat severe blood loss and burns. Albumin Blood Vessel

18. Albumin is found in plants, animals, and in foods such as milk and eggs, and in the milk of a nursing mother. Eggs Whites Animals Plants Small amounts of albumin are found in some erythropoietin (EPO) compounds. Currently, research to produce albumin, from non-blood plasma sources, is underway. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely.

19. Immunoglobulins (Antibodies) Immunoglobulins are a type of protein found in plasma. They makes up to 3% of plasma. They are the body’s defense (immune system) against invading viruses and bacteria. Most adults have an immune system that helps to prevent or fight disease. Fetuses or babies up to 3 months old, do not produce antibodies. The fetus receives its protection from the placenta of the mother. Babies when born receive their immunity through breast milk. This is called passive immunity. Blood Conservation Services helping you choose wisely. Save Blood. Save Lives.

20. Immunoglobulins (Antibodies) Immunoglobulins are also used in some medicines for the treatment of certain infections, such as tetanus, dipththeria, rabies. It is also used to counteract the effects of snake or spider venom. Blood Conservation Services helping you choose wisely. Save Blood. Save Lives.

21. Blood Conservation Services helping you choose wisely. Save Blood. Save Lives. Fresh Frozen Plasma Slow Thaw Hard Spin to Separate Clotting Factors and Cryoprecipitate Clotting factors and cryoprecipitate are another type of protein found in plasma and make up 1% of plasma. They are made by slowly thawing fresh frozen plasma and then spinning it through a centrifuge. Clotting factors are used to help the blood to clot to control bleeding. They are used in medical glues to seal wounds and some surgical openings. Cryoprecipitate is a combination of clotting factors that may be used to treat hemophilia and other excessive bleeding disorders. Clotting Factors/Cryoprecipitate

22. Save Blood. Save Lives. Fractions from Red Blood Cells Hemoglobin Hemin Blood Conservation Services helping you choose wisely. Currently, not used at McLeod

23. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely. Fractions from White Blood Cells Interferons Interferons are a complex class of proteins which fight off viral infections and inflammation. They are used in the treatment of hepatitis and some HIV related infections and some forms of cancer.

24. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely. Made from DNA technology, Neupogen stimulates bone marrow to increase white blood cells to fight against infection and inflammation. It may be used to treat patients receiving chemotherapy or bone marrow transplant recipients. It contains no human blood fractions. Synthetic Immune Enhancer

25. Save Blood. Save Lives. Blood Fractions from Platelets To date, there are no fractions derived from platelets as an alternative therapy to blood transfusion. Platelets are used to rapidly stop bleeding. Since platelets are a main blood component, it may not be acceptable to Level I patients. Blood Conservation Services helping you choose wisely.

26. Save Blood. Save Lives. Therapies for elective surgery Blood Conservation Services helping you choose wisely. Erythropoietin (EPO) Stimulating Agents Intravenous (IV) Iron Cell Saver

27. Normal Blood Oxygen Levels How erythropoietin (EPO) stimulating agents work Blood Conservation Services helping you choose wisely. Save Blood. Save Lives. Injection of EPO Agent 4 Increases Erythropoietin Production 5 Increase in Red Bone Marrow 6 7 Increase in Red Blood Cells can mean Increase in oxygen to tissue Normal Blood Oxygen Levels Low oxygen in the blood 2 Kidney releases erythropoietin 3 1 Low Red Blood Cells or increased tissue demand for oxygen

28. Blood Vessel Spleen Tissues Liver Bone Marrow How intravenous (IV) iron work Iron stored as Ferritin Hemoglobin uses Iron Red Blood Cells carry more oxygen Aging RBCs Fe Blood Conservation Services helping you choose wisely. Fe Save Blood. Save Lives.

29. Step 1: Blood from surgery site is mixed with solvent to keep from clotting 1 Step 2: Blood is filtered to remove large clots and other debris 2 Step3: Blood is spun through a centrifuge 3 Step 4: Washed at the same time 4 5 Step 5: Waste from red blood cells are collected in receptacle Step 6: Washed red blood cells are collected for re-infusion 6 Step 7: Red blood cells are reinfusion 7 How cell saver works Blood Conservation Services helping you choose wisely. Save Blood. Save Lives.

30. Other Types of Procedures Blood Conservation Services helping you choose wisely. Hemodilution Heart-Lung Machine Dialysis Epidural Blood Patch Plasmapheresis Labeling/Tagging Platelet Gel

31. Save Blood. Save Lives. Blood Conservation Services helping you choose wisely. Plasmapheresis or Plasma Exchange Plasmapheresis (pictured to the right) is a process where excess plasma is removed from the body. Then albumin or IV fluids may be used to replace the plasma that has been previously withdrawn. This process is used to treat many autoimmune diseases. A Level I patient would not receive another person’s plasma in the place of his or her own plasma.

32. Blood Conservation Services helping you choose wisely. Save Blood. Save Lives. Platelet Gels, Tissue Adhesives A small amount of patient’s own blood is withdrawn, separated and then concentrated into a solution to form a gel. Platelet gel seals wounds which reduces bleeding.

34. Save Blood. Save Lives. RECAP What therapies are used for elective surgery? What are blood fractions? Blood Conservation Services helping you choose wisely. Erythropoeitin (EPO), Intravenous Iron (Venofer), and Cell Salvage Blood fractions are proteins normally found in blood that are separated out for use as treatment. Human blood fractions include albumin, immunoglobulins, cryoprecipitate, clotting factors and interferons.

35. Save Blood. Save Lives. What will you do? Will you accept all blood fractions? Blood Conservation Services helping you choose wisely. Your choice is a personal matter! Will you refuse all blood fractions? Will you accept some blood fractions and refuse others?