Therapeutic Options to Minimize Allogeneic Blood Transfusions and Their Adverse Effects in Cardiac Surgery: A Systematic Review

Abstract

IntrodutionAllogeneic blood is an exhaustible therapeutic resource. New evidence indicates that blood consumption is excessive and that donations have decreased, resulting in reduced blood supplies worldwide. Blood transfusions are associated with increased morbidity and mortality, as well as higher hospital costs. This makes it necessary to seek out new treatment options. Such options exist but are still virtually unknown and are rarely utilized.ObjectiveTo gather and describe in a systematic, objective, and practical way all clinical and surgical strategies as effective therapeutic options to minimize or avoid allogeneic blood transfusions and their adverse effects in surgical cardiac patients.MethodsA bibliographic search was conducted using the MeSH term “Blood Transfusion” and the terms “Cardiac Surgery” and “Blood Management.” Studies with titles not directly related to this research or that did not contain information related to it in their abstracts as well as older studies reporting on the same strategies were not included.ResultsTreating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, reducing routine phlebotomies, utilizing less traumatic surgical techniques with moderate hypothermia and hypotension, meticulous hemostasis, use of topical and systemic hemostatic agents, acute normovolemic hemodilution, cell salvage, anemia tolerance (supplementary oxygen and normothermia), as well as various other therapeutic options have proved to be effective strategies for reducing allogeneic blood transfusions.ConclusionThere are a number of clinical and surgical strategies that can be used to optimize erythrocyte mass and coagulation status, minimize blood loss, and improve anemia tolerance. In order to decrease the consumption of blood components, diminish morbidity and mortality, and reduce hospital costs, these treatment strategies should be incorporated into medical practice worldwide.

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

“…Therefore, a lower preoperative platelet count with function impaired by CPB would contribute to excessive bleeding and the requirement for RBC transfusion. Actively warming hypothermic patients and cooling febrile patients in the postoperative period are also actions proposed to minimize blood transfusion in cardiac surgery (7) .…”

“…Some of the actions that comprise an approach to minimize allogeneic blood transfusion in cardiac surgery include diagnosing and treating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, and selective laboratory evaluation (7) . All these actions count on systematic nursing activities.…”

“…One of the preoperative components that comprise optimization of the erythrocyte mass in order to minimize blood transfusion is early nutrition, with protein supplementation to support erythropoiesis (7) . Nursing caring for patients preoperatively must ensure accurate anthropometric assessment and documentation, and they must have the opportunity to intervene and optimize nutrition.…”

“…A nontransfusional approach during pre-, intra-, and post-operative care has been recently proposed, including optimizing the erythrocyte mass and coagulation status, minimizing blood loss, and tolerating anemia (7) .…”

Therapeutic Plasma Exchange Ameliorates Incompatible Crossmatches

“…Red blood cell (RBC) transfusion is a risk factor for mortality and morbidity in coronary artery bypass graft (CABG) surgery, and transfusion-related adverse effects may be catastrophic in these patients [1,2,3,4]. Unfortunately, there are no recommendations for these patients regarding how to proceed in the case of incompatible crossmatch tests against donors’ blood.…”