Auto transfusion, including intra-operative cell salvage, is only one of the techniques
currently in use.
It must be integrated with other blood conservation techniques to ensure maximum safety for
patients. With careful pre-operative planning and a team approach, treatment can be given which
is tailored to individual patients' conditions and the operative procedures involved. There is
no one alternative that applies in all cases. The key is to apply multiple alternatives in a
planned way.
Transfusion alternatives programmes are placed under three basic principles or pillars:
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Tolerance of Anaemia:
Calculations are made of the initial RBC mass, the expected RBC loss and the tolerable RBC
loss in order to determine that procedures can be carried out safely without allogeneic
blood transfusion.
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Optimising RBC Mass:
The mass of circulating RBCs (red blood cells) can be optimised by inexpensive haematinics:
- iron
- folic acid
- vitamin B12
The administration of EPO (erythropoietin), 10 to 21 days before surgery, in combination
with intravenous iron therapy can accelerate red cell production to within a range of 45% -
50% haematocrit. Extensive further information is available from the BBT Toolkit website:
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Minimising Blood Loss:
Surgical and anaesthic techniques can be applied to further reduce the risk of
allogeneic blood transfusion. Techniques such as:
- patient positioning
- regional rather than general anaesthesia
- maintenance of normothermia
- haemodilution
- induced hypotension
- meticulous surgical and haemostasis techniques
- haemostatic agents
- cell salvage
- micro sampling
- quick trauma response
- proactive pre-operative management of patients on anti-coagulation and/or
anti-platelet therapy
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