Falsification or paradigm shift? Toward a revision of the common sense of transfusion

Farrugia, Albert

doi:10.1111/j.1537-2995.2010.02817.x

Cited by 17 publications

(19 citation statements)

References 48 publications

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“…Anemia is known to be an independent risk factor for perioperative morbidity and mortality [39] and severe anemia (haematocrit <29) is associated with a significant increase of postoperative in-hospital mortality [40,41]. Naturally, anemia is associated with an increased rate of transfusions [38,[42][43][44] and large retrospective data analyses have revealed an association of blood transfusion rates with postoperative complications, for example increased probability of defective wound healing, tumor recurrence and even mortality [45,46]. However, it remains unclear whether anemia is a risk factor per se because anemia predisposes to transfusion and transfusion itself is related to adverse outcomes, or anemia is just an epiphenomenon of fragility and poor nutritional status, as is for instance hypoalbuminemia.…”

Section: Other Risk Factorsmentioning

confidence: 99%

Epidemiology of the high-risk population

Boehm

Baumgarten

Hoeft

2015

Current Opinion in Critical Care

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Section: Other Risk Factorsmentioning

confidence: 99%

Epidemiology of the high-risk population

Boehm

Baumgarten

Hoeft

2015

Current Opinion in Critical Care

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“…The patient blood management paradigm shift in transfusion medicine (Farrugia 2011 ) not only saves lives, but reduces health care costs (Spahn et al 2012 ). It should be therefore part of good clinical practice.…”

Section: Implementation Of Patient Blood Managementmentioning

confidence: 99%

Patient Blood Management

Theusinger

Kind

Spahn

2014

Perioperative Hemostasis

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“…Based on prior reports and our experience thus far, we follow 5 tenets of patient blood management in caring for bloodless patients at our institution [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][26][27][28] : (1) minimizing iatrogenic blood loss for laboratory testing, (2) tolerating lower hemoglobins, (3) diagnosing and treating preoperative anemia, (4) salvaging intraoperative blood, and (5) optimizing surgical hemostasis (Table 1). We request that all surgical patients seeking bloodless care obtain a preoperative complete blood count as soon as possible, preferably at least 4-8 weeks before the surgery.…”

Section: Our Recommendations For Bloodless Medicinementioning

confidence: 99%

“…[1][2][3] In fact, several academic health centers are establishing "Bloodless Medicine & Surgery Programs" that specialize in treating patients who do not accept allogeneic blood transfusions (ABTs). [4][5][6][7][8][9][10][11][12][13][14][15][16] A multidisciplinary approach is frequently required to optimize clinical outcomes for these patients, particularly in the setting of multiple comorbidities or high-risk surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Bloodless medicine: what to do when you can't transfuse

Resar¹,

Frank

2014

Hematology

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A better understanding of risks associated with allogeneic blood transfusions (ABTs), along with a growing population of patients who do not accept transfusions, have led to the emergence of new treatment paradigms with "bloodless medicine." In this chapter, we review prior studies describing management and outcomes in patients who refuse transfusion (referred to as "bloodless patients" herein) and summarize the approaches used at our institution. Bloodless management for surgical patients includes treatment of preoperative anemia, use of autologous blood salvage, and minimizing blood loss with procedures. Other adjuncts for both medical and surgical patients include minimizing blood loss from laboratory testing using pediatric phlebotomy tubes and conservative testing. Anemia can be treated with erythropoiesis-stimulating agents, as well as iron, folate, and B12 when indicated. Although there are limited retrospective studies and no prospective studies to guide management, prior reports suggest that outcomes for surgical patients managed without ABTs are comparable to historic controls. A recent risk-adjusted, propensitymatched, case-control study of outcomes of all hospitalized patients who refused ABT at a large academic health center showed that bloodless management was not an independent predictor of adverse outcomes. Surprisingly, there was a lower overall mortality in the bloodless group and discharge hemoglobin levels were similar for both bloodless and control groups. Further research is now needed to optimize therapy and identify novel interventions to manage bloodless patients. Lessons learned from bloodless patients are likely to benefit all patients given recent evidence suggesting that patients who avoid ABTs do as well, if not better, than those who accept transfusions. Learning Objectives• To describe patient populations for whom transfusions are not an option • To discuss prior studies with outcomes and "bloodless medicine" • To outline currently available approaches to manage anemia or bleeding in "bloodless patients" • To discuss areas in need of further research to advance bloodless medicine

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Falsification or paradigm shift? Toward a revision of the common sense of transfusion

Cited by 17 publications

References 48 publications

Epidemiology of the high-risk population

Epidemiology of the high-risk population

Patient Blood Management

Bloodless medicine: what to do when you can't transfuse

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