Transfusion
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Comparative Study
Acute normovolemic hemodilution is a cost-effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy.
Preoperative autologous blood donation is accepted as a standard of care for radical prostatectomy. Acute normovolemic hemodilution (ANH) is an alternative method for obtaining autologous blood. The cost and benefits of these two autologous blood-collection techniques are compared. ⋯ An integrated blood conservation program utilizing hemodilution and a defined transfusion trigger can decrease the requirement for preoperative donation of blood for autologous use in radical prostatectomy. Point-of-care autologous blood procurement is more cost-effective than preadmission donation of autologous blood units.
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Successful blood substitutes, when infused in place of an equal volume of whole blood, provide similar delivery of oxygen to the tissues without introducing abnormalities in cellular metabolism. ⋯ Polyethylene glycol-hemoglobin solution, like whole blood but in contrast to physiologic saline or dextran solution, was capable of returning the mean arterial blood pressure, cortical oxygen pressures, and extracellular dopamine nearly to control levels after acute blood loss in newborn piglets.
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Patients with cancer often develop significant anemia, which traditionally has been successfully managed by transfusion. Although substantially safer than in the past, transfusions continue to carry a variety of risks. The recent licensing of erythropoietin now provides a second treatment option, which indicates a need to reassess the use of transfusion to manage anemia in these patients. ⋯ Careful assessment by hematologists and oncologists of the risk:benefit ratio of erythropoietin and transfusion in patients with cancer is urged.