Blood Transfusion Strategies in Elective Vascular Surgery

Abstract

Intraoperative Cell Salvage (ICS) Cell salvage as the preferred method in infrarenal surgery is universally available, but, on the other hand, it is necessary to have special equipment and trained staff while a theoretical disadvantage of ICS is the removal of plasma active functional coagulation factors, thus increasing coagulopathy [1]. Two types of devices for intraoperative autotransfusion have been developed. The first type collects the shed blood, washes and centrifugally separates out the red blood cells (RBCs), and then returns them back. During this process, platelets and clotting factors are also removed [2-5]. The second major type of autotransfusion device for hemofiltration alone collects the blood, filters it, and re-infuses it. These devices return all of the blood elements, including the platelets and the coagulation factors, but they do not remove any potentially harmful debris and contaminants [2-6]. The justification of using cell salvage in vascular surgery has two reasons: the first one is to avoid the need to transfuse allogeneic blood with all the involved risk, and the second one is cost-effectiveness because aortic surgery is associated with higher blood loss within surgery [7]. The main cited published studies, both randomized and retrospective non-randomized studies which assess the cell-salvage technique in infrarenal aortic surgery are mentioned in the following text. Randomized Studies with ICS Clagett et al. [8] published a randomized trial of intraoperative transfusion during aortic surgery. In this study, 100 patients who underwent AAA repair or aortofemoral bypass for occlusive disease were randomized to ICS (cell salvage) and control group. No significant differences were found in estimated blood loss, allogeneic blood transfusion (unit administered intraoperatively, postoperatively, and total), proportion of patients not receiving allogeneic blood (34% of patients randomized to ICS and 28% in control patients), postoperative

Patient blood management strategies in vascular surgery

“…Iron deficiency is categorized as either absolute (iron deficiency anemia) or functional (anemia of inflammation, also referred to as anemia of chronic disease). Surgery may be delayed depending on the cause and degree of anemia, the urgency of the procedure, the expected amount of blood loss, and other risk factors [11][12][13].…”

“…The guidelines of the European Society of Cardiothoracic Surgery, the European Association of Cardiothoracic Anesthesiology, and the Society of Cardiovascular Anesthesiologists recommend that preoperative erythropoietin (EPO) and intravenous iron supplementation should be considered in iron deficiency anemia for anemic cardiac surgery patients [10][11][12].…”