|
Overview :
Transfusion of allogeneic blood is associated with a variety
of hazards to a patient. Minimizing the need for allogeneic blood can reduce
these risks in a patient undergoing surgery.
General ways to reduce amount of blood transfused in a
surgical patient:
(1) reduce loss
(2) maximize red blood cell production
(3) maximize oxygen delivery
(4) lower threshold level when to transfuse (tolerate lower
hemoglobin values)
NOTE: These recommendations assume elective surgery and
might not be appropriate for a patient
requiring urgent or emergency surgery.
Stages:
(1) preoperative
(2) perioperative
(3) postoperative
Preoperative:
(1) Take a
complete history, including tendency to bleed and a description of any previous
surgeries.
(2) Perform
laboratory screening tests, including a complete blood cell count and
coagulation screening tests. If blood loss is expected, submit a specimen to
Blood Bank (Type and Hold, Type and Screen or Type and Crossmatch).
(3) Consider
autologous blood collection.
(4) Consider
erythropoietin to increase red blood cell production.
(5) Treat any
iron, folate or vitamin B12 deficiency.
(6) Stop
aspirin or other drugs with antiplatelet activity sufficient to remove effect
by time of surgery (7 days for aspirin).
(7) Weigh the
patient and estimate the blood volume.
(8) If the
patient is receiving anticoagulants, develop a plan to reverse prior to
surgery.
Perioperative:
(1) Consider acute normovolemic hemodilution.
(2) If
available and the surgery appropriate, consider intra-operative red blood cell
salvage.
(3) Consider
hypotensive surgery if appropriate.
(4) Warm all
fluids to avoid hypothermia.
(5) During
surgery maintain meticulous hemostatis. Consider use of fibrin glues and
sealants.
(6) Use of
pharmacologic agents (tranexamic acid, DDAVP, aprotonin) to reduce bleeding.
Postoperative:
(1) Accept a
lower postoperative hemoglobin concentration before transfusing.
(2) If
transfusion is necessary, limit the number of units transfused (preferably 1)
unless the patient is hemorrhaging.
(3) Use
supplemental oxygen.
(4) Prescribe
iron, folate and vitamin B12.
|