Eliminating blood transfusions: New aspects and perspectives
Preoperative autologous blood donation and the use of erythropoietin are efficacious preoperative strategies. Intraoperatively, ANH, cell salvage, pharmacologic treatment with antifibrinolytics, specific anesthesiology and surgical techniques, coagulation monitoring-based transfusion algorithms, acceptance of minimal hemoglobin values, and soon artificial oxygen carriers may be used to avoid allogeneic RBC transfusions. Cell salvage, antifibrinolytics, and accepted minimal hemoglobin values may also be used in the postoperative period. All of these techniques have been used efficaciously in certain situations and form the basis of an integral concept to avoid allogeneic RBC transfusions. Two major goals remain: (1) these strategies have to be implemented in general clinical practice; and (2) the most efficacious techniques and combinations thereof need to be defined for individual patients.