Blood Utilization

Abstract

BACKGROUND:

Traditionally, single-unit red blood cell transfusions were believed to be insufficient to treat anemia, but recent data suggest that they may lead to a safe reduction of transfusion requirements. We tested this hypothesis by changing from a double- to a single-unit red blood cell transfusion policy.

DESIGN AND METHODS:

Abstract

INTRODUCTION:

A significant proportion of all red cell transfusions are given to patients undergoing elective orthopaedic surgery. Concern over transfusion safety and cost, coupled with evidence showing that restrictive transfusion policies benefit patients, prompted us to audit our blood prescribing practice at Gloucestershire Hospitals NHS Foundation Trust in order to assess the appropriateness of every transfusion episode following elective primary total hip replacement.

METHODS:

Abstract

Abstract

BACKGROUND:

Transfusion of red blood cells (RBCs) remains controversial in patients with septic shock, but current practice is unknown. Our aim was to evaluate RBC transfusion practice in septic shock in the intensive care unit (ICU), and patient characteristics and outcome associated with RBC transfusion.

METHODS:

Abstract

Source

Division of General Internal Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA. carson@umdnj.edu

Abstract

BACKGROUND:

The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture.

Summary Spiess and colleagues from the Virginia Commonwealth University Health System in Virginia present their two initial phases in setting up a multidisciplinary blood conservation program. The first phase involved establishing and monitoring transfusion triggers. The second phase, they state, involved “pursuing new and innovative methods to avoid transfusion.” They discuss the impediments to and elements of success in setting up such a program and the benefits accrued to patients, the community and the institution.

Summary Garcia-Erce and colleagues have previously reported on a blood saving protocol utilizing perioperative intravenous (IV) iron and recombinant human erythropoietin (rHuEPO) in patients undergoing surgery for hip fracture (Carcia-Erce JA, et al).

Summary Moonen and colleagues present a review of the literature and summarize perioperative strategies and modalities for blood management in orthopedic surgery. Approaches reviewed include the role of meticulous surgical technique, hypotensive epidural anesthesia, restrictive transfusion triggers, preoperative management of NSAIDs and anticoagulation medications, antifibrinolytic drugs and preoperative erythropoietin therapy and iron supplementation.