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Strategies to reduce the use of blood products: a European perspective


Theusinger, O M; Felix, C; Spahn, D R (2012). Strategies to reduce the use of blood products: a European perspective. Current Opinion in Anaesthesiology, 25(1):59-65.

Abstract

PURPOSE OF REVIEW: Anemia is the most common hematologic problem preoperatively. In itself it compromises the outcome of surgical patients, and additionally results in more frequent allogeneic red blood cell (RBC) transfusions which again independently compromise patient outcome. In elective cardiac surgery as well as in other surgical specialties the use of a patient blood management program will minimize the exposure to blood products, lead to a cost reduction and improve patient's outcome. The aim of this review is to discuss the rationale for patient blood management, explain patient blood management in detail including modern and future transfusion strategies. RECENT FINDINGS: The risk for allergenic RBC transfusions is increased by preoperative anemia. The adverse outcome in recipients of RBC transfusions has recently been shown to be caused rather than only associated with RBC transfusions. In Jehovah's witnesses undergoing cardiac surgery patient blood management programs have been established effectively, demonstrating that it is possible to correct preoperative anemia and avoid RBC transfusions resulting in better outcomes. SUMMARY: Patient blood management strategies are based on an interdisciplinary multimodal approach including early preoperative recognition and treatment of anemic patients, surgical efforts to minimize blood loss, optimal perfusion strategies to reduce hemodilution and continuous assessment of the bleeding and coagulation status of patients as well as a restrictive volume management. This allows specific and goal-directed treatment of patients, preventing anemia in elective patients, optimizing patient's coagulation status early, minimizing exposure to blood products, reducing costs and improving patient's outcome.

PURPOSE OF REVIEW: Anemia is the most common hematologic problem preoperatively. In itself it compromises the outcome of surgical patients, and additionally results in more frequent allogeneic red blood cell (RBC) transfusions which again independently compromise patient outcome. In elective cardiac surgery as well as in other surgical specialties the use of a patient blood management program will minimize the exposure to blood products, lead to a cost reduction and improve patient's outcome. The aim of this review is to discuss the rationale for patient blood management, explain patient blood management in detail including modern and future transfusion strategies. RECENT FINDINGS: The risk for allergenic RBC transfusions is increased by preoperative anemia. The adverse outcome in recipients of RBC transfusions has recently been shown to be caused rather than only associated with RBC transfusions. In Jehovah's witnesses undergoing cardiac surgery patient blood management programs have been established effectively, demonstrating that it is possible to correct preoperative anemia and avoid RBC transfusions resulting in better outcomes. SUMMARY: Patient blood management strategies are based on an interdisciplinary multimodal approach including early preoperative recognition and treatment of anemic patients, surgical efforts to minimize blood loss, optimal perfusion strategies to reduce hemodilution and continuous assessment of the bleeding and coagulation status of patients as well as a restrictive volume management. This allows specific and goal-directed treatment of patients, preventing anemia in elective patients, optimizing patient's coagulation status early, minimizing exposure to blood products, reducing costs and improving patient's outcome.

Citations

21 citations in Web of Science®
28 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:review
Language:English
Date:2012
Deposited On:27 Mar 2012 12:13
Last Modified:05 Apr 2016 15:18
Publisher:Lippincott Wiliams & Wilkins
ISSN:0952-7907
Publisher DOI:10.1097/ACO.0b013e32834dec98
PubMed ID:22113184

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