Spanish Consensus Statement on Alternatives to Allogeneic Blood Transfusions: The Seville Document

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SUMMARY Preoperative anemia is an independent risk factor for allogeneic blood transfusion in patients undergoing major orthopedic surgery (MOS) whereas hematinic deficiency can delay the recovery from postoperative anemia. Both conditions can, however, be corrected before elective procedures are undertaken. We therefore evaluated the prevalence of anemia and hematinic deficiencies in MOS patients. Demographic and laboratory data were gathered from all MOS patients from a single institution between January 2001 and December 2002. A total of 715 patients (483 women/232 men) entered the study. According to WHO criteria, the prevalence of anemia was 10.5% and increased with age, without gender‐related differences. Preoperative hemoglobin was < 13 g/dL in 19.4% of patients, and the prevalence of hematinic deficiencies was 33% for iron, 12.3% for vitamin B12 and 3% for folate. In anemic patients, there were 30.8% with hematinic deficiency anemia (20% with iron‐deficiency anemia), 30.8% with anemia of chronic disease and 38.4% with anemia of mixed or indeterminate cause. The prevalence of anemia, as well as of hematinic deficiencies, is high in MOS patients. Therefore, whenever possible, patients undergoing MOS should be assessed early enough to allow for proper investigation and treatment prior to the scheduled procedure.

Section: Introductionmentioning

confidence: 99%

Prevalence of preoperative anemia and hematinic deficiencies in patients scheduled for elective major orthopedic surgery

Bisbe

Castillo

Sáez

et al. 2008

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“…Transfusion and risk reduction rates tend to vary widely from one center to another 11 . The accepted indication for this technique is elective surgery with a transfusion risk higher than 20% or 30%, 29,30 bearing in mind that the efficacy of PABD varies considerably between centers depending on the transfusion protocol. In this study, PABD was used almost exclusively in patients scheduled for orthopedic surgery.…”

Section: Discussionmentioning

confidence: 99%

Descriptive study of perioperative transfusion practices in Spanish hospitals

Basora¹,

Moral²,

Llau

et al. 2008

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SUMMARY In order to identify opportunities to enhance blood‐sparing strategies, we studied blood‐transfusion practices in patients undergoing scheduled major surgery in Spain. This prospective, multicenter epidemiological study involved 20 Spanish hospitals. We recorded the pre‐ and postoperative hemoglobin concentrations, the estimated and calculated blood loss, the number of patients transfused and the blood‐sparing techniques used. A total of 359 patients from 18 centers were included in the analysis. Mean preoperative hemoglobin concentration was 13.7 ± 1.6 g/dL. In 29% of the patients, preoperative hemoglobin concentration was lower than 13 g/dL. All surgeries combined, mean estimated blood loss was 845 ± 659 mL and mean calculated blood loss 1722 ± 1021 mL. The percentage of patients transfused with allogeneic blood was 28.4% altogether and ranged from 47.2% in cardiac surgery patients to 4.5% in plastic‐maxillofacial surgery patients. Blood‐sparing techniques were used only in 70 patients (19.4%). For a large percentage patients who underwent scheduled major surgery, blood transfusion was needed and perioperative blood loss was underestimated. Blood‐sparing techniques were underused in non‐orthopedic surgery, despite the fact that sufficient time was available to plan appropriate blood‐sparing measures.

“…Allogeneic blood transfusions are necessary for up to 25% of patients after shoulder arthroplasty because of perioperative blood loss‐induced anemia 4,5 . However, there are transfusion‐associated risks, such as immunomodulation, or errors in blood administration, that have led to the development of different strategies to reduce or avoid the need for ABT 7,8 . Among them, the acceptance of a lower transfusion threshold seems to play a capital role, because many ABTs might be administered inappropriately 7,8 .…”

Section: Discussionmentioning

confidence: 99%

“…ABT is a scarce and increasingly expensive resource and is not risk‐free. Overall concerns about adverse effects of ABT have prompted several scientific societies to develop evidence‐based guidelines and recommendations on the indications and alternatives to ABT, the final objective of which was a more rational and restrictive approach to its use 7,8 . In this study, we evaluated the efficacy of the implementation of a restrictive transfusion protocol to reduce ABT requirements in patients undergoing hemiarthroplasty surgery for PFH.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a restrictive transfusion protocol reduces the need for allogeneic blood transfusion in proximal humerus fracture repair without affecting patient outcome: preliminary observations

Cuenca

García-Erce

Múñoz

et al. 2008

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SUMMARY Shoulder arthroplasty may be associated with considerable blood loss, and some patients require allogeneic blood transfusion (ABT). However, there is almost no information available for proximal humerus fracture (PHF) repair surgery. We therefore evaluated the influence of two transfusion protocols on ABT requirements in patients undergoing hemiarthroplasty surgery for PFH. We assessed the requirements for ABT in 78 patients receiving hemiarthroplasty for PHF, who were managed with a conservative transfusion protocol [hemoglobin(Hb) < 9.0 g/dL; group 1; n = 31] or a restrictive transfusion protocol (Hb < 8.0 g/dL and/or clinical signs/symptoms of anemia/hypoxemia; group 2; n = 47). Overall, the ABT rate (12% vs. 48%; P = 0.001) and the transfusion index (0.2 ± 0.7 vs. 0.9 ± 1.0 unit/patient; P = 0.001) were lower in group 2 than in group 1. The differences in transfusion rate and transfusion index between groups were significant for patients with Hb < 13.0 g/dL (75% vs. 18%, for groups 1 and 2, respectively; P = 0.001), but not for those with Hb ≥ 13.0 g/dL (20% vs. 7%; P = 0.180). The implementation of a restrictive transfusion protocol seems to be effective in reducing ABT, especially in PHF patients with preoperative Hb < 13.0 g/dL.