Clinical orthopaedics and related research
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Three of four recipients of transfusion in the United States are patients undergoing surgery, and despite promising advances in the development of alternatives to allogeneic blood transfusion, it is likely that for years to come this patient population will remain dependent on blood donated by volunteers. The safety of the blood supply has been questioned seriously since it became known that the human immunodeficiency virus could be transmitted by transfusion. In response to this threat, enforcement of strict donor eligibility criteria, removal of high risk donors from the donor pool, and testing of each donation with a panel of viral markers were instituted which have reduced the infectious risks of allogeneic blood transfusion dramatically during the last decade. The current safety of the blood supply is reviewed and the ongoing efforts to improve the safety of transfusions in the future are summarized briefly.
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Acute normovolemic hemodilution was described to be useful as a blood conservation strategy more than 25 years ago, yet seldom is practiced today. The benefit of acute normovolemic hemodilution is perceived to be modest and the technique is not taught in anesthesia or surgery training programs. Acute normovolemic hemodilution is an autologous blood procurement strategy that is superior to the predeposit of autologous blood for several reasons: Acute normovolemic hemodilution is less costly, with an average cost of $25 per unit compared with $175 per unit predonated; and acute normovolemic hemodilution units are reinfused to patients before the patient leaves the operating room, so that the units need not be tested and there is no possibility of administrative error. Emerging clinical studies now show that acute normovolemic hemodilution is equivalent to predonated autologous blood in reducing allogeneic blood exposure in patients undergoing elective surgery.
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Clin. Orthop. Relat. Res. · Dec 1998
An algorithm to optimize perioperative blood management in surgery.
Innovation in surgical blood management has been fueled by patients' perceptions of the risks associated with allogeneic blood transfusions and by surgeons' attitudes toward the use of allogeneic blood. The challenge is to determine the best blood management strategy to implement in the individual patient, particularly in patients with anemia who are at high risk of allogeneic blood transfusion. ⋯ The algorithm uses patient weight, gender, and preoperative hematocrit level to derive the volume of blood loss that can be tolerated while maintaining a target postoperative hematocrit level. Because the margin of safe blood loss can be anticipated, the most appropriate blood conservation option(s) can be implemented and perioperative blood management can be optimized.