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 | | 3.4 There have been great improvements in the availability and effectiveness of transfusion alternatives |
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Autotransfusion, including intra-operative cell salvage, is only one of the techniques currently in use.
It must be integrated with other blood conservation techniques to ensure maximum safety for patients. With careful pre-operative planning and a team approach, treatment can be given which is tailored to individual patients' conditions and the operative procedures involved. There is no one alternative that applies in all cases. The key is to apply multiple alternatives in a planned way.
Transfusion alternatives programmes are placed under 3 basic principles or pillars:
 | Tolerance of Anaemia:
Calculations are made of the initial RBC mass, the expected RBC loss and the tolerable RBC loss in order to determine that procedures can be carried out safely without allogeneic blood transfusion.
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| Optimising RBC Mass:
The mass of circulating RBCs (red blood cells) can be expanded by inexpensive haematinics:
- iron
- folic acid
- vitamin B12
The administration of EPO (erythropoietin), 10 to 21 days before surgery, in combination with intravenous iron therapy can accelerate red cell production to within a range of 45% - 50% haematocrit. For example, see Guidelines for Anaemia Management provided by Venofer, a manufacturer of an iron sucrose injection.
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| Minimising Blood Loss:
Surgical and anaesthesiological techniques can be applied to further reduce the risk of allogeneic blood transfusion. Techniques such as:
- patient positioning
- regional rather than general anaesthesia
- maintenance of normothermia
- haemodilution
- induced hypotension
- meticulous surgical and haemostasis techniques
- haemostatic agents
- cell salvage
- micro sampling
- quick trauma response
- proactive pre-operative management of patients on anti-coagulation and/or anti-platelet therapy
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| The standard policy on anaemia treatment is based on a transfusion trigger of a haematocrit of 30% or a haemaglobin level of 10 g/dcl for all patients, thresholds that date back to an article by Adams and Lundy published in 1942. Today, many physicians consider this "magic figure" to be inappropriate.
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| LEARNING GUIDE
To be sure to pass the Test in module 3.4, learn the 3 pillars of transfusion alternatives programmes, listed above.
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