Many patients have cultural or religious reasons for refusing blood products. Dr. Suman Rao, chief of hematology at MedStar Franklin Square Medical Center, explains how she has developed new skills and a new viewpoint that enable her to treat patients successfully while respecting their right to refuse blood transfusion.

I treat a lot of patients with lung cancer, but I also see a number of patients with blood disorders and anemias.

I think there was a time when we would say to patients you do it our way or not, but I think more and more we do respect patient’s wishes.

We consider their cultural beliefs, their religious beliefs. It is sometimes that that sense of, oh my god, the hemoglobin is five and the patient’s refusing a transfusion, or it’s four and they are refusing a transfusion.

We have to make people understand that this can be managed, there are ways and techniques to manage this, and if done properly, many patients, if not all of them, will do well with it.

We had a patient here who was transferred from another hospital for an amputation and they would not do it there because her hemoglobin was four, four and a half. We optimized her and she went for her amputation and did well with the hemoglobin around seven but was adequate for anesthesia.

I think it’s very important that we make sure that we do what the patient’s need, that we respect their wishes, and that we’re able to give them the treatments that are sometimes denied to them because of that.

Avoiding transfusions is better in general in whatever way we can.

We know transfusions can cause reactions.

We know with transfusions, although the blood is very well checked now, and infectious complications are pretty minimal, there’s still that risk.

There is some concern that the transfusions can actually reduce the immune function, and that patients who receive a lot of transfusions actually tend to do worse.

So I think in that sense it is better to try and limit transfusions as much as possible for every patient.