Blood conservation strategies and the management of perioperative anaemia

Shander, Aryeh; Javidroozi, Mazyar

doi:10.1097/aco.0000000000000179

Cited by 26 publications

(8 citation statements)

References 51 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several blood conservation strategies are available that can reduce surgical blood loss and they are indispensable tools in preserving an already limited and compromised resource: the patient's own blood. 63,64 Finally, it is important to remember that management of anemia does not end with the surgery. Anemia remains a significant and common problem in the postoperative setting.…”

Section: Discussionmentioning

confidence: 99%

How I treat anemia in the perisurgical setting

Shander

Kaufman²,

Goodnough

2020

Blood

Self Cite

View full text Add to dashboard Cite

Anemia is a common finding in perioperative setting with significant untoward consequences including worsening of outcomes and diminished quality of life as well as increased risk of allogeneic blood transfusions. Here we present three cases that illustrate how anemia can be perioperatively managed in patients undergoing cardiac, orthopedic and oncology surgeries. Timely detection of anemia prior to high-blood loss surgeries can allow clinicians to manage it and optimize hemoglobin level, making patients better prepared for the surgery. Treatment of anemia should be guided by the etiology and may include erythropoietic agents, folic acid, B12 and iron preparations. Other blood management strategies geared toward reducing surgical blood loss such as autologous transfusion techniques and agents to optimize hemostasis are employed during surgery and in the immediate post-operative period. Patients should be closely monitored following the surgery for signs of ongoing bleeding in need of control. Finally, screening for and management of anemia should continue in the post-operative and post-discharge period, as persistence and recurrence of anemia can further undermine patient's outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

How I treat anemia in the perisurgical setting

Shander

Kaufman²,

Goodnough

2020

Blood

Self Cite

View full text Add to dashboard Cite

show abstract

“…A concomitant reduction in RBCC consumption from 2010 to 2011 by 1.3%, from 2011 to 2012 by 2.2%, and from 2012 to 2013 by 6.5% was observed, presumably due to a more restrictive use of blood products and the introduction of the concept of 'patient blood management' [22]. Simultaneously, the number of WBDs per 1,000 inhabitants has decreased from 2011 to 2013 from 61 to 57, whereas the number of apheresis donations per 1,000 inhabitants still increased from 2011 to 2013 from 33 to 34 [13].…”

Section: Development Of the Supply With Wbdsmentioning

confidence: 96%

Blood Product Supply in Germany: The Impact of Apheresis and Pooled Platelet Concentrates

Berger

Schopohl

Wittmann³

et al. 2016

Transfus Med Hemother

View full text Add to dashboard Cite

Background: In Germany, about 60% of all produced platelet concentrates (PCs) are apheresis PCs (APCs). Ongoing discussions on APC reimbursement and costs might lead to a potential shift in pooled PC (PPC)/APC production. Objective of this analysis was to build a comprehensive model from the societal perspective to evaluate consequences associated with shifts in platelet supply and demand. Methods: Literature search, desktop researches on platelet supply and demand. Model calculations, time horizon one year: model input from the Paul-Ehrlich-Institute, data 2013. Base case: 19.2% of annual whole blood donations (WBDs) were used for production of 38.5% PPCs, decay of 46,218 PCs (8.0%). Scenarios calculated: variation in PPC proportion of 10-100%. Results: Base case: during PPC production 41,957-83,913 red blood cell concentrates (RBCCs) are estimated to be lost, which corresponds to 1-2% of annual RBCCs in Germany. Scenarios were calculated for a production of 60-100% PPCs: loss is estimated to be 1.5-5.0% of annual RBCCs (65,430-218,099), decay 54,189-69,022 PCs (9.4-12.0%). Conclusion: Production of different blood components is interlinked and sensitive to unidimensional decisions. Increasing PPC proportion has negative impact on the RBCC production and on the antigen-matched APC donor pool. Completion of the model calculations to predict the optimal PPC/APC proportion would require evidence on the number of refractory patients, donor pool sizes, and incidences of diseases requiring platelet transfusions.

show abstract

“…PBM (also known as Blood Conservation or Bloodless Medicine/ Surgery) is an evidence-based, multidisciplinary approach aimed at optimizing the care of patients who might need transfusion [17][18][19]. PBM represents an international initiative to improve patient outcomes by promoting the use of transfusion of blood and components only when clearly required.…”

Section: What Is Patient Blood Management (Pbm)?mentioning

confidence: 99%

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Freedman¹

2016

J Perioper Crit Intensive Care Nurs

View full text Add to dashboard Cite

Despite increasing recognition of the potential adverse effects of blood transfusion there is evidence that the procedure is over-utilized and often inappropriately and unnecessarily administered. Patient Blood Management (PBM) is a recent world-wide initiative to optimize transfusion therapy by employing preoperative and perioperative maneuvers and alternatives to avoid unnecessary blood transfusion. These approaches are, however, not restricted to the surgical setting, but may be applied whenever transfusion is contemplated. A key component of PBM is the appropriate management of anemia, a prime determinant of transfusion. Another is tolerance of anemia through the use of restrictive transfusion thresholds for transfusion and of a single unit at a time policy. Among a number of options at surgery, antifibrinolytics have proven effective at reducing blood loss and transfusion. Burgeoning literature demonstrates that PBM (also known as Blood Conservation or as 'Bloodless Medicine/Surgery') is costeffective while improving patient outcomes and conserving the blood supply. Data from the ONTraC program in Ontario are described herein to illustrate the effectiveness of PBM approaches.

show abstract

Blood conservation strategies and the management of perioperative anaemia

Abstract: Despite the high prevalence of anaemia and the significant toll it takes on patients, simple and effective strategies are available to detect, diagnose and treat it.

Cited by 26 publications

References 51 publications

How I treat anemia in the perisurgical setting

How I treat anemia in the perisurgical setting

Blood Product Supply in Germany: The Impact of Apheresis and Pooled Platelet Concentrates

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Contact Info

Product

Resources

About