here we go....
the reasons for giving blood transfusions vary; blood loss can be chronic (over a long period of time)or acute. In acute blood loss with shock, yes, blood is given to expand the volume of the circulation, but it is also given to help the oxygen carrying capacity- blood contains haemoglobin that can carry oxygen around the body, volume expanders (such as Haemaccell) do not. If you only transfuse a volume expander, then the patient's blood pressure will go up, but they will not necessarily benefit, because putting the blood pressure up increases bleeding, if it has not yet been stopped.
I was involved with the care of a 16yo boy, whose family were JW. He had crashed a motorbike and had severe leg injuries, and was bleeding profusely. He refused blood, and when his parents arrived, and he lost consciousness, they also refused to let us use it. He was given all the support he could have been short of blood, his blood pressure was fine, but you just can't survive without haemoglobin.He died. What was more galling for our team, was that the family then complained at the inquest that we had not done enough to save him.
Chronic blood loss and elective surgery are different issues. Chronic anaemia can sometimes be treated with a hormone, EPO, which stimulates the bone marrow to produce new red blood cells (but it takes weeks to work, so not of any use in acute blood loss).
Whilst it is true that transfusion is not risk-free, it is wrong to say that "The medical profession is slowly coming to understand that this is a highly recommendable way to perform surgery". We have always attempted to minimise blood loss during surgery, and only transfuse if the patient is likely to come to some harm from not having blood (e.g. being anaemic, with not enough oxygen in the blood can precipitate heart attacks and strokes).
In my area and field, I do not have many patients who are JW. Many of my operations can be done without blood loss, so it wouldn't be a problem, but I would reserve my right not to offer an operation to a JW who "insisted on bloodless surgery". The death of a patient does not only affect the patient and his/ her family,it upsets everyone who has been involved to a certain degree. I feel I have a duty to protect the Junior medical staff and nursing staff from that sort of situation. The conditions my patients complain about are rarely life-threatening, but the operations can be.
Oh, and another thing. Blood is not cheaper than the alternatives. No way.Certainly not in the UK. It has been proved time and time again, that blood transfusion is costly. That is one of the reasons why our transfusion service are trying to minimise the amounts we use (as well as the shortage of donors and risks involved, too).