Bloodless surgery in geriatric surgery

Abstract

In bloodless surgery a series of measures has to be implemented to reduce the perioperative need for transfusion of whole blood or its components. Jehovah's Witness are the most representative group of patients opting for bloodless surgery as their faith follows strict believes that prohibits receiving blood. Geriatric patients requiring bloodless surgery are even more delicate and represent a challenge for surgeons. The physiological response of the over 65 year population to decreased hemoglobin level is slower and less effective than in young and adult patients. Herby we describe the perioperative protocol implemented in our surgical Department offered to geriatric Jehovah's Witness patients. Preoperative optimization of the patients is the key step in the preparation period. Intraoperative anesthetic and surgical measures are also required along with a strict postoperative follow-up. From our experience, bloodless surgery is feasible in the geriatric population as long as it is performed in specialized centers where a multidisciplinary team is prepared to specifically manage this scenario. Rigorous patients selection and preparation are mandatory.

Blood transfusion rates and predictors following geriatric hip fracture surgery

“…Preoperative optimisation through risk assessments, use of erythropoietin and careful planning of the surgical procedure has been shown to allow for reduced perioperative need for transfusions in geriatric patients undergoing major surgery. 31 The need for blood transfusions has also been reduced by use of preoperative administration of recombinant human erythropoietin, or iron with or without erythropoietin, and perioperative cell salvage. 5 Receiving preoperative erythropoietin and iron was not associated with increased mortality in geriatric patients undergoing hip fracture surgery.…”

Blood Management for the Orthopaedic Surgical Patient

“…Implementation of controlled hypotension through the anesthetic can lower mean arterial pressure during surgery and decrease bleeding; however, the anesthetic needs to be carefully administered to maintain organ perfusion (Palmer et al, 2020). Use of interventions to avoid hypothermia via temperature management with reflective blankets and warm IV fluids is important because hypothermia can affect platelet function thereby contributing to blood loss (Guarino et al, 2014; Palmer et al, 2020).…”

Bloodless Management of the Anemic Patient in the Emergency Department

“…9 Jehovah's Witnesses believe that acceptance of blood transfusions will damage their relationship with God; because of this, their avoidance of blood product transfusions has been described as a religious obligation, not an option. 10 Jehovah's Witnesses may also decline the administration of plasma-derived proteins, such as albumin, coagulation factors, and fibrin sealants such as Gelfoam, as these are derived from blood. Additionally, there are procedures performed in the ED that involve the transfer of blood and thus may be unsuitable for Jehovah's Witnesses; such procedures include hemodialysis, epidural blood patch placement, extracorporeal membrane oxygenation, plasmapheresis, and tagged red blood cell scans.…”