Author(s): Victor Lage de Araujo
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Hemotherapy has been deservedly considered a heroic therapy, despite some adverse effects. After the
HIV pandemics, awareness about transfusion-associated diseases (e.g. HIV, HBV/HDV, HCV and HTLV
virus; the protozoan Trypanosomiasis and Malaria) challenged us to associate chronic diseases to trans
fusional events. Notwithstanding excellent diagnostic tools, a significative probability of transmission
remains. Acute Transfusion Reactions are rare; those findings have increased consciousness about subtle
immunohematology troubles. Despite ABO/Rh compatibility, about 20 different remaining antigen systems
are the root of Erythroblastosis fetalis and delayed haemolysis. Modern hemotherapy uses fractioned Hemecomponents rather than whole blood – Meaning optimisation of the blood supply and focused therapeutics.
However, further technologies are paramount for Patient Blood Management. Determining the patient’s iron
profile will assure his haematopoiesis is at its best before surgery. The management of selected patients with
supplements and recombinant human erythropoietin shows favourable results. A previous autologous blood
donation will result in the availability of those units post-operatively. It is possible to program a preoperatory haemodilution (i.e. calculated harvesting of blood in the immediate preoperatory). The surgical losses will be of lesser concentration, and the blood will be available post-operatively. Through the process of “cellsaving”, blood picked from the surgical site is aseptically processed into concentrated Red Blood Cells (in
isotonic saline) for an immediate return. The personalisation of laboratory Ht/Hb decision thresholds limits
transfusion with the substitution for alternatives. For patients requiring chronic regimens, judicious use
means saving excessive use and increasing tolerance.