Expert Opinions > Expert Medical Opinions > Professor Hirokazu Iida

Professor Hirokazu Iida

Asia | Japan

EXTRACTS FROM OPINION, DATED OCTOBER 15, 2024: 

“From September 2000 to March 2017, as Chief Professor of Orthopedic Surgery at Kansai Medical University, I provided bloodless surgery to patients who refused blood transfusions at the affiliated hospital. The majority of these patients were Jehovah’s Witnesses. Fortunately, there have been no cases where a patient died as a result of not receiving a blood transfusion.

The operations I performed included total hip replacement surgery, bilateral same-day surgery, and revision hip arthroplasty.

Fortunately, hip replacement surgery is an elective procedure, so there is no concept of being “too late”. With the skill of an orthopedic surgeon, it is possible to perform surgery that improves function in any situation. In addition, over the past 20 years, there have been significant technological advancements and improvements in hip replacement surgery itself, leading to reduced intraoperative blood loss without the need for extreme hypotensive anesthesia. In particular, with the cemented hip replacements we perform, postoperative bleeding from the bone marrow is minimized. Furthermore, since joint replacement surgery requires strict aseptic conditions to prevent infection, such as the use of clean rooms and exhalation ventilators, it is usually unnecessary to perform allogeneic blood transfusions—even for patients who do not refuse transfusions—if autologous blood salvage is used, except in very special cases. Many of the younger orthopedic surgeons I have trained approach surgery with the same mindset.

In recent years, it has become clear that allogeneic blood transfusions entail risks such as 1) fever and urticaria caused by antibodies from pregnancy or previous transfusions, 2) post-transfusion graft-versus-host disease (GVHD), and 3) infectious diseases such as hepatitis and acquired immune deficiency syndrome (AIDS).” (Original in Japanese.)