Homologous blood transfusion is not required in surgery for adolescent idiopathic scoliosis

Abstract

We studied 70 consecutive patients with adolescent idiopathic scoliosis who underwent corrective surgery. They were divided into two groups. In the study group of 38 patients one or more modern blood-conservation measures was used peri-operatively. The 32 patients in the control group did not have these measures. Both groups were similar in regard to age, body-weight, the number of levels fused and the type of surgery. Only two patients in the study group were transfused with homologous blood and these transfusions were 'off-protocol'. Wastage of autologous pre-donated units was minimal (6 of 83 units). By contrast, all patients in the control group were transfused with homologous blood. In the study group there was a significant decrease (p = 0.005) in the estimated blood loss when all the blood-conservation methods were used. The use of blood-conservation measures, the lowering of the haemoglobin trigger for transfusion and the education of the entire team involved in the care of the patient can prevent the need for homologous blood transfusion in patients undergoing surgery for adolescent idiopathic scoliosis.

Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis

“…Routine use of blood conservation measures can decrease the need for allogeneic blood transfusion [18]. These techniques are varied and include intraoperative controlled hypotension (directly reducing the volume of blood lost) and acute normovolaemic haemodilution which reduces the proportion of red cells lost intraoperatively [18,31,32].…”

“…These techniques are varied and include intraoperative controlled hypotension (directly reducing the volume of blood lost) and acute normovolaemic haemodilution which reduces the proportion of red cells lost intraoperatively [18,31,32]. Infusion of antifibrinolytic drugs such as tranexamic acid can also decrease the need for allogeneic blood transfusion by competitive inhibition of the activation of plasminogen to plasmin [22,33].…”

“…Infusion of antifibrinolytic drugs such as tranexamic acid can also decrease the need for allogeneic blood transfusion by competitive inhibition of the activation of plasminogen to plasmin [22,33]. The evidence for the clinical benefit and cost-effectiveness of intraoperative blood salvage is more variable, with many studies showing a decreased need for transfusion with its use [18]. However, Weiss et al [34] demonstrated no benefit in use of a cell saver when comparing 95 consecutive patients undergoing PSF for scoliosis correction.…”

“…Methods of reducing intraoperative blood loss with substantial supporting evidence include controlled intraoperative hypotension, acute normovolaemic haemodilution, intraoperative autologous blood salvage and use of antifibrinolytic agents such as tranexamic acid [18][19][20][21][22][23].…”

11 Anesthesia for Scoliosis Surgery

“…72 Studies have shown that a combined approach to blood conservation makes it possible to avoid allogenic blood transfusions. 45,53,73,74 However, until their efficacy and adverse effects are resolved through further trials, clinicians must weigh the cost and consequences of hemostatic medications and blood conservation techniques against the risk of substantial perioperative blood loss and of allogenic blood transfusions. 75 …”