AGH Pioneers Innovative Treatment for Colon Cancer Patients Who Refuse Blood Transfusion

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While treating a patient who refuses blood transfusions on religious grounds, a team of physicians at Allegheny General Hospital developed a new way of treating colon cancer that could help other patients who prefer bloodless surgery.

The way we treated Mr. Tomolonis is intuitive and makes sense, but it requires a team approach to treating individual patients.

At age 74, John Tomolonis spent his summer taking down trees, clearing trails and cutting grass at his sprawling 31-acre property in Bellaire, Ohio.

Mr. Tomolonis embraced the chores with a new passion this summer—just a year ago he was too weak to tackle them, or most activities. In March of 2012 Mr. Tomolonis learned that his exhaustion was caused by colon cancer – which had caused him to become severely anemic.

“I didn’t have any energy. I just wanted to sit around all the time,” he said.

A daunting diagnosis for anyone, colon cancer and the internal bleeding it caused presented additional challenges for Mr. Tomolonis. As one of Jehovah’s Witnesses, Mr. Tomolonis refuses blood transfusions on religious grounds.

Mr. Tomolonis was referred to Allegheny General Hospital’s Center for Bloodless Medicine and Surgery where a team of physicians created a custom treatment plan to address his health needs while respecting his religious beliefs. In the process, they developed a new way of treating colon cancer patients who refuse blood transfusions.

Mr. Tomolonis required surgery to remove cancer from his colon. But, first, he needed medical intervention to stabilize the amount of hemoglobin, the protein in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs, in his blood.

A healthy hemoglobin level for an adult man is at least 12.4 grams per deciliter of blood (gm/dL). By the time he was referred to AGH’s Center for Bloodless Medicine and Surgery, Mr. Tomolonis’ hemoglobin was dangerously low at 5 gm/dL.

He was too weak for surgery to remove the cancer and stop the bleeding, but his continual blood loss would make it difficult to improve his hemoglobin levels with medication.

AGH physicians developed an innovative plan to stem his blood loss, treating his bleeding tumor with a short course of radiation to cause enough cell death to stop the bleeding.

“Precise targeted radiation therapy offered a unique solution for Mr. Tomolonis to temporarily arrest his tumor and stabilize the bleeding,” said AGH radiation oncologist Alexander Kirichenko, MD.

With the blood loss under control, physicians were able to prescribe medication, iron supplements and dietary changes to gradually bolster Mr. Tomolonis’ hemoglobin level. Within a month, he was healthy enough to undergo the final phase of his treatment, a minimally-invasive surgery in which colorectal surgeon James McCormick, DO removed the damaged, cancerous portion of his colon.

“The way we treated Mr. Tomolonis is intuitive and makes sense, but it requires a team approach to treating individual patients,” said Jan C. Seski, MD, medical director of the Center for Bloodless Medicine and Surgery. “We incorporated treatment modalities from a lot of different disciplines and brought them to bear in one case and achieved a very good outcome.”

Following surgery, Mr. Tomolonis was able to get back to enjoying an active lifestyle with his family and has the energy to play with his great grand children again.

He said finding a program that could incorporate the expertise and resources of colorectal surgeons, general surgeons, radiation oncologists, gastroenterologists and bloodless medicine specialists into a plan tailored to his needs was essential. Standard colorectal cancer surgery with blood transfusions to give him an immediate hemoglobin boost wasn’t an option he was willing to consider.

“We have a lot of medical information available today and we know there can be successful alternatives for people do not want transfusions,” Mr. Tomolonis said. “At Allegheny General, it was my choice to make. There was never any pressure either way.”

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Editors Note: Experts in bloodless medicine from around the globe will convene in Pittsburgh September 20-22 for the Society for the Advancement of Blood Management annual meeting in Pittsburgh at Soldiers and Sailors Memorial Hall, Oakland. Allegheny General Hospital physicians Jan C. Seski, MD, and Arvind Venkat, MD along with Rita Schwab, CPMSM, AGH bloodless medicine program director, will participate in a workshop on ethical considerations in blood management on September 21 at 10:15 a.m. For more information on the conference, visit

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Jennifer Davis