From Bloodless Surgery to Patient Blood Management

Shander, Aryeh; Javidroozi, Mazyar; Perelman, Seth I.; Puzio, Thomas; Lobel, G

doi:10.1002/msj.21290

Cited by 88 publications

(85 citation statements)

References 69 publications

(64 reference statements)

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“…in case of Jehovah's Witness patients) and blood conservation (strategies to avoid and minimize allogeneic blood transfusions [14]). PBM is defined as 'the timely application of evidencebased medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome' [What is PBM?…”

Section: Anaemia and Patient Blood Managementmentioning

confidence: 99%

Blood conservation strategies and the management of perioperative anaemia

Shander

Javidroozi

2015

Current Opinion in Anaesthesiology

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Section: Anaemia and Patient Blood Managementmentioning

confidence: 99%

Blood conservation strategies and the management of perioperative anaemia

Shander

Javidroozi

2015

Current Opinion in Anaesthesiology

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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%

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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“…7 Intraoperatively, meticulous haemostasis is essential. Some surgeons prefer to use shorter procedures, whereas others may modify their technique, choosing laparoscopic over open techniques to reduce the blood loss even though the procedure may take longer.…”

Section: Long Answermentioning

confidence: 99%