Blood conservation techniques in obstetrics: a UK perspective

被引:51
作者
Catling, S. [1 ]
机构
[1] Singleton Hosp, Dept Anaesthesia, Swansea SA2 8QA, W Glam, Wales
关键词
blood conservation; obstetrics; preoperative autologous donation; acute normovolaemic haemodilution; intraoperative cell salvage;
D O I
10.1016/j.ijoa.2007.01.014
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
In the UK, maternal mortality due to haemorrhage appears to be rising, with obstetric haemorrhage accounting for 34% of the red cells transfused. Allogeneic blood transfusion carries risks such as administration errors, transmitted infections and immunological reactions. The supply of blood is decreasing, partly due to the exclusion of donors who have themselves received a blood transfusion since 1980, in order to stop transmission of variant-Creutzfeldt-Jakob disease. The cost of blood is significantly increasing, partly because it is now leucocyte-depleted to minimize viral transmission. Various blood conservation techniques can reduce exposure to allogeneic blood thereby reducing risk and conserving the blood supply. These include preoperative autologous donation, acute normovolaemic haemodilution and intra-operative cell salvage. Preoperative autologous donation may produce anaemia, does not eliminate transfusion risk, cannot be used in an emergency and is not acceptable to Jehovah's Witnesses. It should be reserved for exceptional circumstances (rare blood type or unusual antibodies). Acute normovolaemic haemodilution may induce anaemia and cardiac failure and cannot be used in an emergency. It may have a limited role in combination with other techniques. Intra-operative cell salvage is more effective and useful in obstetrics than the other techniques, overcomes their shortcomings and is endorsed by CEMACH, OAA/AAGBI Guidelines, the National Blood Service and NICE. (C) 2007 Elsevier Ltd. All rights reserved.
引用
收藏
页码:241 / 249
页数:9
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