Blood conservation strategies and bloodless medicine

Abstract

Blood transfusion is a commonly performed procedure perioperatively by anesthesia providers. Historically there have been several scenarios where transfusions are avoided due to various risks, refusal by patients, or even simply unavailable. Blood conservation strategies have been developed as means of decreasing or completely eliminating the need for allogeneic blood transfusion. Patients who receive blood transfusions face the intrinsic risk of blood transfusion as developing transfusion reactions, blood borne infection, and transfusion related immunomodulation. Blood transfusions in the perioperative setting are associated with increased rates of pulmonary, wound, and thromboembolic complications as well. Bloodless medicine/surgery encompasses the multidisciplinary strategies that can be implemented in the preoperative, intraoperative, and postoperative phase to minimize transfusion rates. Bloodless medicine has also been employed in the care of Jehovah's Witnesses, who may refuse transfusions of specific blood components. Blood conservation strategies are being implemented in the care of the orthopedic patient, as the rate of blood transfusions for joint replacement in the United States is currently rising. In cardiac surgery, limiting blood transfusions leads to decreased postoperative complications and mortality. As bloodless medicine continues to advance technologies and techniques are developed to meet patient needs.