PERIOPERATIVE INTERVENTIONS TO DECREASE TRANSFUSION OF ALLOGENEIC BLOOD PRODUCTS

Objective: To discuss some of the many options available for decreasing perioperative transfusion of allogeneic blood products. Design: We review the issues that focus on the goal of developing an appropriate transfusion strategy in consideration of the individual patient's preexisting conditions, physiologic requirements, perioperative stress, and coagulation status. Results: Increased awareness of transfusion-related morbidity from allogeneic blood products has resulted in increased development and application of alternatives to allogeneic transfusion. Preoperative donation and perioperative collection of autologous blood and blood products decrease exposure to allogeneic blood. Pharmacologic agents, such as antifibrinolytics, may also decrease the need for allogeneic transfusion. Perioperative use of laboratory tests of coagulation function facilitates the rapid and specific diagnosis of coagulation disorders. Conclusion: Physicians now have considerable appreciation of the risks and benefits of blood product transfusion. This knowledge has resulted in conservative and scientific approaches to therapy for perioperative bleeding and coagulopathy.