Roma. When he meets his first patient who refuses blood, Dr. Patrizio Mazza, hematologist and Director of the Complex Structure of Hematology and Transplant Section at the Moscati/SS Annunziata in Taranto, lives that moment with “pathos; the young woman was a girl with autoimmune hemolytic anemia, her hemoglobin was 4,5, and as a Jehovah's Witness she refused blood, she was well conscious, and I as a doctor had the duty to do something and cure her.
If I found myself working as a doctor in the desert without a blood donor, what would I do? If I don't have blood, what do I do? I don't treat?" Asked by Dire for the in-depth analysis dedicated to medicine without blood, the hematologist Mazza, a pioneer in the treatment of blood tumors in non-transfused patients and author of over 150 scientific articles published in national and international journals on the results achieved on patients affected by leukemia and lymphoma and other pathologies who refused blood, has no doubts about the fact that, for ethical reasons and out of respect for self-determination, but also for clinical evidence, "we must devise a strategy in this perspective".
CHANGE GUIDELINES, BE STRATEGIC
“Hematologists must think,” he reiterates, underlining how this can lead, “even being ready to deviate and modify the expected guidelines,” to results and advantages for the patients themselves, whether they are motivated by religious factors or other reasons. “The message I want to give is that it can be done, hematologists must start thinking and there is no need to send a 22-year-old girl from Turin all the way here, or a 36-year-old boy from Milan all the way here, to Taranto.”
“That anemic girl,” he says, returning to that first meeting, “according to the guidelines, it was necessary to give cortisone at 1,5 mg per kilo if she had accepted transfusions. I came up with another solution, giving cortisone at 7 mg per kilo and in 3 days the hemolytic anemia was resolved, with a dose 5 times higher and with the necessary precautions and I discovered that you can cure anemia like this, giving less toxicity to the patient than what is foreseen in the guidelines that require a long period and cortisone is more toxic than if given for 3 days and I discovered it in that circumstance.” A discovery for the benefit of all that Mazza would not have made if he had remained glued to the protocols without thinking about different paths.
CASES OF LEUKEMIC PATIENTS –
On leukemia patients in the same way there are people who without blood are obtaining a remission of the disease, what counts is the timeliness. "We had the first Jehovah's Witness patient in '94, in Taranto we have been treating these patients for 28 years, 2.500 have passed and they have been treated without blood and we have performed 55 autotransplants without any deaths".
"If patients come here from Milan, Rome, Turin, Arezzo, Naples, Palermo, what does it mean?" asks Mazza. "There is still distrust throughout Italy, there is a tendency to not want responsibility and to avoid it and I think this is the real problem. If you agree to treat patients who refuse blood, you will have to develop personalized strategies, the relatives will ask you a lot of questions every day about why the hemoglobin does not rise and you have to be there explaining that the marrow has its own times", "if destroyed - the expert points out - it does not produce blood and this happens in 2 circumstances: for aplasia of the marrow which is total destruction, or for acute leukemia.
In these two situations, on one side there is an empty marrow and on the other it is occupied by tumor cells that prevent the healthy ones from producing”, but even in these extreme situations it is possible to operate using bloodless medicine.
"In aplasia - explains Mazza - the issue is time, the marrow must be reactivated in a few weeks and the patient can recover if stimulated by drugs; in the case of acute leukemia, one must act promptly by destroying the leukemia cells, allowing the healthy ones to regenerate. These are two extreme situations, but in the middle there are many where there is no complete destruction and where operationally the doctor can juggle and devise strategic systems and the patient who does not want to be transfused, not only Jehovah's Witnesses, can be treated while safeguarding this desire".
BLOODLESS TRANSPLANTS
“There is no problem with autotransplantation - clarifies the Director of Hematology at Taranto - if you start with good hemoglobin there is no problem with red blood cell transfusion, if anything platelets but the risk of hemorrhage due to lack of platelets is very low, and lasts 4 or 5 days in autotransplantation”.
In the case of donor transplants, "we have performed 2 successfully - he underlines - a patient who was now 20 years old with chronic myeloid leukemia that at the time was not treated with modern drugs and recently a 39-year-old French patient with the same leukemia and in the accelerated phase with resistance to modern drugs and she came out of the transplant brilliantly with a complete remission. Just 3 months have passed, we cannot say how things will go but the operative result was there".
THE IMPORTANCE OF TIME
“Today we are following 5 patients with acute leukemia at the onset who ask to be treated without blood because they are Jehovah's Witnesses and of the five who are undergoing therapy, 2 are in complete remission and another 3 are in progress. There were a few patients who knowingly refused transfusions that we were unable to treat, but it happened not because we could not use blood, but because the patients started therapy when their hemoglobin was already too low at 3 or 4, and we had waited too long to activate the therapy. In their path there had already been a diagnosis when they had hemoglobin at 8 or 9. If the therapy had been started immediately the outcome would have been different. It is therefore essential - reiterates Mazza - to start therapies immediately after the diagnosis”.
So in the "first patient with autotransplant - recalls Dr. Mazza - I also had the problem and instead of procrastinating with the therapy we started a concentrated program of 4 days with the same drugs that are used on 7, we gained 3 days on the risk of hemorrhage and we understood that the problem of red blood cells does not exist in the patient who has an autotransplant and if he starts with a hemoglobin of 10 or 11 it does not go below 7 and if he has a healthy heart he does not risk anything, he stays in bed peacefully. We also understood that the risk of platelet reduction is very limited, of very few days, they go below 10 thousand for 4 or 5 days and if there are no vascular defects or predisposition to bleeding nothing happens".
MEDICAL CULTURE AND GUIDELINES – “In Italy, this is the problem,” concludes hematologist Mazza, “there is no culture of saying ‘we need to come up with a system that is a little different from the guidelines’. In medicine, guidelines provide general recommendations, but when we are faced with a patient who does not accept blood, these must be adapted, not overturned, the treatment path is the same but with different times. Hematologists should think about the strategy for the individual patient, dictated by age, type of disease, characteristics, the stage of the pathology and the need for reasoning and strategies without the use of blood for that patient who does not accept it must be taken into account by the doctor”.
The field experience of Dr. Patrizio Mazza, who made the SS. Annunziata hospital in Taranto a point of reference, is not destined to remain unique. The numerous scientific publications document a legacy of knowledge to be systematized in scientific societies, among hematologist colleagues, to whom the expert has launched a strong appeal, so that other patients are no longer forced to journeys of hope, also risking losing precious time to find the protection of a right: to be treated with respect for one's freedom of thought and belief.
BIBLIOGRAPHICAL NOTES, PATRIZIO MAZZA PUBLICATIONS:
Approximately 150 papers published in national and international journals with a focus on clinical research on lymphomas: Haematologica Leukaemia and Lymphoma, Bone Marrow Transplantatio, Journal of clinical oncology and Blood;
Ex multibus: Autologous and allogeneic stem cell transplant in Jehovah's Witnesses: a single-center experience on 22 patients – PubMed (nih.gov);
Myeloablative therapy and bone marrow transplantation in Jehovah's Witnesses with malignancies: single center experience – PubMed (nih.gov).
Article published on 27 July 2022 - 20:06
