Modifying Perioperative Blood Loss

Continued concerns over the risks of using allogeneic blood, especially those of transfusion-transmitted infection, combined with occasional shortage of donor blood and increasing costs (with the introduction of universal leucodepletion in the wake of variant-CJD), have stimulated interest in perioperative blood conservation. Two broad approaches to blood conservation have been pursued. The first is to accept that blood loss is inevitable and to use measures to conserve patients' blood. Measures, such as, autologous blood pre-deposit have received increasing interest as have the use of autotransfusion, the venesection of one unit prior to CPB and reinfusion of residual oxygenator blood after bypass, the use of cell savers, and the acceptance of a normovolaemic anaemia postoperatively. These measures have been poorly applied in the UK mainly because of the high cost associated with formal programmes. The second approach to blood conservation is to prevent blood loss at the time of surgery by using pharmacological methods.202

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