An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery

Slappendel, R.; Dirksen, R.; Weber, E. W. G.; Schaaf, Dick B. van der

doi:10.1080/00016470310017974

Cited by 64 publications

(36 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with planned elective surgeries should be screened for underlying anemia as soon as possible. 12,17 Iron replacement and ESAs have been studied preoperatively as a way of preemptively correcting anemia.…”

Section: Prehospitalization Settingmentioning

confidence: 99%

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

2016

View full text Add to dashboard Cite

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesis-stimulating agents, and erythropoietin.Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes. Data Synthesis: A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none. Conclusions: In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery.

show abstract

Section: Prehospitalization Settingmentioning

confidence: 99%

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

2016

View full text Add to dashboard Cite

show abstract

“…The combination of algorithms for blood management and restrictive transfusion thresholds offers a better approach to blood conservation than the implementation of single interventions such as autologous transfusion. 14,15 Much of the evidence suggesting a benefit from autologous transfusion is derived from methodologically poor studies with inadequate clinical outcomes. 15 Pre-operative Sufficient time should be allocated for the identification and treatment of anaemia, ideally in the setting of a surgical pre-assessment clinic.…”

Section: Strategies For Reducing Blood Use In Surgical Patientsmentioning

confidence: 99%

“…15 Pre-operative Sufficient time should be allocated for the identification and treatment of anaemia, ideally in the setting of a surgical pre-assessment clinic. 14 Drugs that interfere with haemostasis should be discontinued wherever possible. Predeposit autologous transfusion is no longer recommended as a strategy for blood conservation because there is no evidence of better clinical outcome; there are also practical problems in scheduling surgery, which causes inconvenience for patients.…”

Section: Strategies For Reducing Blood Use In Surgical Patientsmentioning

confidence: 99%

Strategies for reducing the exposure to donor blood

Murphy

2005

Clinical Medicine

View full text Add to dashboard Cite

Why is there a need to reduce the use of blood?The quality and safety of blood in the UK are among the best in the world but, like all other clinical procedures, the transfusion of donor blood is not risk free. The most logical approach to reducing the risk of transfusion is to use blood only when strictly clinically necessary and where there are no alternatives. There have been recent, essentially unfunded, initiatives to promote the appropriate use of blood and the avoidance of transfusion, 1,2 and the Chief Medical Officer made a number of practical recommendations in his 2003 annual report (Table 1). 3 It appears that these efforts are having some effect: the demand for blood in England and North Wales, which steadily increased during the 1990s, has successively reduced by 1%, 1% and 6% over the last three years.However, it is likely that blood usage could be further reduced without compromising patient safety.High quality evidence about clinical outcomes associated with blood transfusion has only recently been provided. Recent randomised controlled trials have shown that using less blood neither impairs nor improves patient outcome. 4,5 Current practice in surgery and critical care has been strongly influenced by one of these trials which found that a 'restrictive' transfusion strategy using a haemoglobin (Hb) concentration trigger of 7 g/dl showed a trend towards better clinical outcome than a 'liberal' strategy with an Hb trigger of 10 g/dl. 4 Data from over 24,000 patients with acute coronary syndromes demonstrated an association between transfusion and higher 30-day mortality for patients with a nadir haematocrit greater than 25%, suggesting that a haematocrit as low as 25% may be tolerated in otherwise stable patients with ischaemic heart disease. 6 The safety of blood transfusionThe risk of transfusion-transmitted infection (TTI) by donor blood transfusion has never been lower. During the period 1996-2003, data from the UK haemovigilance scheme (Serious Hazards of Transfusion (SHOT)) show that the incidence of death and major morbidity associated with transfusion was 0.39 and 1 per 100,000 units, respectively. 7 The most frequent causes of death were non-infectious complications (Table 2). Major morbidity due to TTI was mostly due to bacterial contamination associated with stored platelet concentrates. The chance that donor transfusion will transmit one of the viruses for which blood is currently tested is very low. The incidence of viral transmission of HIV, HBV and HCV is 4.58, 0.41 and 22.09 per million blood donations, respectively (K Davison; personal communication).Two of the 50 recipients of blood from blood donors known to have developed variant Creutzfeldt-Jakob disease (vCJD) have themselves become infected; one recipient died of vCJD, 8 and the other died of unrelated causes but with histological evidence of vCJD. 9 The cost of providing blood in the UK has greatly increased since 1995, mostly due to measures to reduce the risk of transmission of vCJD and to new microbiological tests. Furth...

show abstract

“…Siekiant išvengti bakterinio užteršimo, rekomenduojama kraują rinkti iš drenų ir reinfuzuoti ne vėliau kaip per 6 val. po operacijos (31)(32)(33).…”

Section: Pooperacinė Kraujo Reinfuzijaunclassified

Transfusion of autologous blood

Veikutienė¹,

Širvinskas²,

Adukauskienė

2008

Medicina

View full text Add to dashboard Cite

ĮvadasPastaraisiais metais, nuolat daugėjant sudėtingų traumų (jų metu nukentėjęs žmogus dažnai labai nukraujuoja), didėjant įvairių ligų chirurginio gydymo galimybėms, plečiantis ortopedinių operacijų apimčiai, didėja alogeninio kraujo perpylimo poreikis (1). Deja, alogeninio kraujo perpylimas susijęs su daugeliu problemų: kraujo, kaip biologinio audinio, išteklių ribotumu, augančiais kraujo paruošimo kaštais, krauju perduodamų infekcinių ligų pavojumi, neigiamu imunomoduliaciniu poveikiu recipientui, pneumonija bei kitomis pooperacinėmis infekcijomis, piktybinių navikų išplitimo bei jų atsinaujinimo rizika (2-9). Yra duomenų, kad alogeninio kraujo perpylimas didina sergamumą, mirtingumą, ilgina lovadienių trukmę intensyviosios terapijos skyriuose gydomiems ligoniams (8).Šios aplinkybės skatina siaurinti ir griežtinti indikacijas donorinio kraujo perpylimui, įdiegti naujus metodus, padedančius išvengti ar bent minimalizuoti alogeninio kraujo transfuzijų poreikį (10-17).Autologinio kraujo perpylimas -tai yra, kai donoras ir recipientas yra tas pats asmuo (paties ligonio kraujo perpylimas). Pastaraisiais metais akivaizdžiai padidėjo susidomėjimas autologinio kraujo panaudojimo galimybėmis, kaip viena tinkamiausių alternatyvų donorinio kraujo perpylimui. Šiuolaikiniai autologinio kraujo moksliniai tyrimai bei klinikinė praktika pateikia naują sampratą apie autologinio kraujo perpylimo praktinę vertę. Autologinio kraujo perpylimas yra pats saugiausias, nes galima išvengti ar bent gerokai sumažinti daugelį potencialių komplikacijų, sukeliamų donorinio kraujo perpylimo. Svarbus autologinio kraujo perpylimo vaidmuo ir kraujo taupymo programoje. Šis kraujo perpylimas geriausias, o dažnai ir vienintelis pasirinkimo būdas tiems ligoniams, kuriems tapataus donorinio kraujo nepavyksta parinkti, kai yra itin reto fenotipo kraujo grupė arba dėl imunizacijos susidarę aloantikūnai (18).Ne visos planinės chirurginės intervencijos susijusios su didesniu nukraujavimu, todėl ne visi ligoniai turėtų būti ruošiami autologinio kraujo perpylimui. Yra keletas autologinio kraujo perpylimo metodų, kurie skirtingiems ligoniams gali būti naudojami atskirai ar įvairiuose deriniuose.Autologinio kraujo perpylimo metodai:

show abstract

An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery

Abstract: An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery , Acta Orthopaedica Scandinavica, 74:5, 569-575,

Cited by 64 publications

References 10 publications

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Strategies for the Management of Postoperative Anemia in Elective Orthopedic Surgery

Strategies for reducing the exposure to donor blood

Transfusion of autologous blood

Contact Info

Product

Resources

About