Multiple ways to avoid surgical hemotransfusion

Author(s): Victor Lage de Araujo

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.
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