Making surgery work for Mayo nurse through Bloodless Medicine and Surgery Program

By In the Loop • January 23, 2023

The Bloodless Medicine and Surgery Program was created to help patients who prefer not to receive donor blood or who are unable to receive blood products. It meant the world to Kenichea Nichols.

Kenichea Nichols, a nursing education specialist at Mayo Clinic in Rochester, is used to advocating for her patients and colleagues. When she learned she needed a serious operation, she found herself leaning on colleagues to advocate for her.

That meant looking at surgery in a different way.

Kenichea has a history of having iron deficiency anemia and low red blood cell count — two factors that increase the risk of surgical complications. It also means an increased likelihood of needing a blood transfusion during surgery.

As one of Jehovah's Witnesses, Kenichea could not accept a blood transfusion. That's where the Bloodless Medicine and Surgery Program came in.

"I had been receiving iron infusions to treat my anemia for a few years. I was taking iron pills and trying to supplement my diet, but it was just in rough shape," Kenichea says. "But my surgeon said they needed to get me in a better position before taking me to surgery."

Kenichea and her surgeon had an open conversation about her beliefs and why it would not be acceptable for her to receive a blood transfusion. With support from her care team, a phone call was made to the Bloodless Medicine and Surgery Program in Rochester.

Considering the needs of all patients

The Bloodless Medicine and Surgery Program was created to help patients who prefer not to receive donor blood or who are unable to receive blood products.

The program aims to reduce and even eliminate the need for traditional blood transfusions during surgery. It offers surgeons a variety of prevention and treatment tools, including a rating mechanism for a patient's bleeding risk based on bleeding and clotting history, and preoperative iron infusions.

Through this holistic approach, surgical care teams can reimagine treatment plans that would traditionally require blood products.

Kenichea met with the Bloodless Medicine and Surgery team to discuss which interventions and blood products she would and would not be willing to accept during surgery.

"I was just so grateful that I was able to have my beliefs respected and to be able to get the care that I needed without being argued with, talked down to or disrespected," she says.

Together, with Matthew Warner, M.D., an anesthesiologist and medical director of Mayo Clinic's Patient Blood Management Program, and Allan Klompas, M.B., B.Ch., B.A.O., an anesthesiologist and associate medical director of the Patient Blood Management Program, the care team determined a surgery preparation plan that would put Kenichea in the best position for surgery.

"Mayo Clinic has long provided support for patients with religious beliefs, such as Jehovah's Witnesses, or (patients with) certain conditions and blood types that restrict their ability to receive blood products," Dr. Klompas says.

A tailored approach

Kenichea was given a significant iron infusion a few weeks before her operation, which boosted her hemoglobin levels.

"The Bloodless Medicine and Surgery Program provides a seamless pathway to ensure these patients receive the best possible care, in accordance with their own blood preferences or medical circumstances," says Dr. Warner.

Not only does the program facilitate respectful, compassionate care, but it also improves patient outcomes. Generally, patients who don't need a blood transfusion during surgery experience better outcomes, including shorter hospitalizations and recovery times.

Considering all aspects of the patient experience makes a real difference, according to Kenichea.

"When you're sick, the last thing you want to do is fight with someone. You're fighting for yourself, you're fighting for your life, you're fighting for your health," she says. "With the Bloodless Medicine and Surgery Program, you don't have to do that because you have somebody else who's advocating for you, who knows what your beliefs are, and they have the medical background to be able to support you."

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