Blood Conservation in Surgery

Surgical procedures account for the transfusion of almost 15 million units of packed red blood cells (RBCs) every year in the United States. “There has been intense interest in blood conservation and minimizing blood transfusion over the past several years, but the number of annual transfusions is increasing,” says Victor A. Ferraris, MD, PhD. “At the same time, the blood donor pool has stabilized or slightly decreased.” Perioperative bleeding that requires RBC transfusion is especially common during cardiac operations, which consume as much as 10% to 15% of the nation’s blood supply. Evidence suggests that this figure is rising, largely because of the increasing complexity of cardiac surgical procedures. “An important part of blood resource management is recognizing patients’ risk of bleeding and subsequent blood transfusion.” In the March 2011 Annals of Thoracic Surgery, the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists published an update to their 2007 blood conservation clinical practice guidelines. Certain features of blood conservation and management of blood resources have been updated or added. The guidelines provide updates in the preoperative management of dual antiplatelet treatment, pharmacotherapy to increase RBC volume or to reduce blood loss, and the use of blood derivatives. They also provide updated strategies to manage blood salvage, information on the use of minimally invasive procedures to reduce perioperative bleeding and need for blood transfusion, and strategies for blood conservation associated with extracorporeal membrane oxygenation and cardiopulmonary perfusion. The use of topical agents for hemostasis and the optimal usefulness of team interventions in blood management are also discussed in the guideline update. Emphasizing Preoperative Risk Assessments The Society of Thoracic...