Importance of Blood Conservation in Cardiac Surgery and Impact on Patients Refusing Blood Product Transfusions

Abstract

-use of blood product transfusion increase risk of mortality by 0.5%/unit of blood transfusion, with approx 3x increase in overall mortality and 2x occurrence of major complication -also association between BPT and length of hospital stay & cost -Respiratory failure, renal failure and increased rate of infection associated with BPT -also exposes risk of major & minor transfusion reactions, induce immuno-suppression and cause systemic inflammatory response which affects all organs [REF#1] -50-60% of cardiac surgery pt require BPT, and almost always in high-risk/emergent operations; own nature of cardiac surgery itself and the use of CPB predisposes the need for BPT -protocol for blood conservation [REF#3] is based on 1) preoperative optimization of Hgb, 2) intraoperative acute normovolemic hemodilution, 3) auto-transfusion, 4) tolerance of permissive anemia (Hgb 6-7); 5) meticulous surgical technique; 6) endovascular vein harvesting; 7) on-site coagulation monitoring; 8) targeted pharmacotherpay (antifibrinolytic agents and desmopressin acetate) -we are moving away from PAD due to high wastage rate (40%