alexa Blood Transfusion Strategies in Elective Vascular Surgery

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Blood Transfusion Strategies in Elective Vascular Surgery

Autotransfusion techniques used in vascular surgery: intraoperative cell salvage (ICS) and acute normovolemic haemodilution (ANH), are evaluated in this article, especially their effectiveness in the reduction of allogeneic blood transfusions and cost. In comparison with ICS, ANH does not need any special equipment, is more accessible and cheaper, but the other method, ICS, is more adopted by vascular surgeons and anaesthetists. Even if ICS is preferred to ANH, only one study among the randomized studies confirmed the convincing benefit of using the cell salvage technique, and only 2 non-randomized studies had similar results, moreover, meta-analyses of these studies have not resolved the dispute over the efficiency of ICS. Only three meta-analyses assessing ICS in a subpopulation of patients who underwent abdominal aortic aneurysm surgery showed a decrease in the use of allogeneic blood and improvement of clinical outcomes. ANH in vascular surgery was evaluated in 6 randomized studies and 1 retrospective study. There was no study, except one, which would evaluate ANH as the only autotransfusion method in vascular surgery. ANH was assessed in combination with ICS and 3 randomized studies confirmed that this combination could be effective in the achievement of the reduction in exposure to allogeneic blood. Because ANH can have an impact on microcirculatory and macrocirculatory levels, two studies evaluated it from this point of view, but without any significant results. For the future, both ANH and ICS can have a potential to save allogeneic blood and money but positive results depend on blood loss and the type of elective infrarenal aortic surgery. ANH should be evaluated separately and in greater detail. Although the general risks of blood transfusion have been reduced during recent years, the risk of the transmission of infectious diseases, bacterial, fungal as well as viral, transfusion reactions, immunosuppression and postoperative infectious complications still remains. To avoid allogeneic transfusion, autotransfusion techniques are preferred. They include the intraoperative cell salvage technique (ICS), acute normovolemic haemodilution (ANH) and preoperative blood donation. Each of the autotransfusion techniques can be used for vascular surgery but some of them have more often been adopted by vascular surgeons. The most popular technique in vascular surgery seems to be intraoperative cell salvage whereas acute normovolemic haemodilution is not used as frequently. Techniques (ICS, ANH), their advantages and disadvantages as well as their effectiveness in the reduction of cost and allogeneic blood transfusions in elective vascular surgery are evaluated in this article.

Citation: Mannova J, Silhart Z, Prokes (2014) Blood Transfusion Strategies in Elective Vascular Surgery. J Blood Disorders Transf 5:233.

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