11/4/2016

Alternativesandadjunctstobloodtransfusion

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TransplantationServices
ProfessionalAdvisoryCommittee

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6:Alternativesandadjunctsto
bloodtransfusion
Essentials
Transfusionalternativesweremostlydevelopedtoreduce
blooduseinsurgerybuthavemuchwiderapplication.
Theyaremosteffectivewhenusedincombinationandaspart
ofacomprehensivepatientbloodmanagementprogramme.
Predepositautologousblooddonationbeforesurgeryisof
uncertainbenefitandnowhasveryrestrictedindicationsin
theUK.
Intraoperativecellsalvage(ICS)iseffective(andmaybelife
saving)inelectiveoremergencyhighbloodlosssurgeryand
managementofmajorhaemorrhage.
Postoperativecellsalvage(PCS)andreinfusioncanreduce
blooduseinjointreplacementandscoliosissurgery.
ICSandPCSareusuallyacceptabletoJehovahsWitnesses.
Tranexamicacid(antifibrinolytic)isinexpensive,safeand
reducesmortalityintraumatichaemorrhage.Itreduces
bleedingandtransfusioninmanysurgicalproceduresand
maybeeffectiveinobstetricandgastrointestinal
haemorrhage.
OfflabeluseofrecombinantactivatedFactorVII(rFVIIa)for
haemorrhagedoesnotreducemortalityandcancauseserious
thromboemboliccomplications.
Erythropoiesisstimulatingagents(ESAs),suchas
erythropoietin,arestandardtherapyinrenalanaemiaandcan
supportbloodconservationinsomecancerchemotherapy
patientsandautologousblooddonationprogrammes.They
mayalsobeeffectiveinselectedpatientswith
myelodysplasia.
ESAsmaycausehypertensionandthromboembolic
problems.Carefulmonitoringisrequiredtokeepthe
haematocritbelow35%.
Safeparenteralironpreparationsarenowavailableandmay
producemorerapidandcompleteresponsesinirondeficiency
anaemia.Indicationsincludeintoleranceoforaliron,support
forESAtherapyandasanalternativetotransfusionin
perioperativeandpostpartumanaemia.

Transfusionalternativeshavelargelybeendevelopedto
reducedonorredcelltransfusioninsurgery,wheretheyare
mosteffectiveaspartofacomprehensivepatientblood
http://www.transfusionguidelines.org/transfusionhandbook/6alternativesandadjunctstobloodtransfusion

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11/4/2016

Alternativesandadjunctstobloodtransfusion

managementprogramme(seeChapter7(/transfusion
handbook/7effectivetransfusioninsurgeryandcritical
care)).Manyofthesetechniqueshavewiderapplication,
rangingfromtraumaticandobstetrichaemorrhagetopatients
whodonotacceptbloodtransfusions.Thischapterbriefly
describesthecommonlyavailabletransfusionalternativesand
theirrationale.Theiruseinspecificclinicalindicationsis
coveredinChapters710and12.
6.1:Autologousbloodtransfusion(collectionandreinfusionof
thepatientsownredbloodcells)(/transfusionhandbook/6
alternativesandadjunctstobloodtransfusion/61autologous
bloodtransfusioncollectionandreinfusionofthepatients
ownredbloodcells)
6.2:Pharmacologicalmeasurestoreducetransfusion
(/transfusionhandbook/6alternativesandadjunctstoblood
transfusion/62pharmacologicalmeasurestoreduce
transfusion)
6.3:Thrombopoietinmimetics(/transfusionhandbook/6
alternativesandadjunctstobloodtransfusion/63
thrombopoietinmimetics)
6.4:Parenteraliron(/transfusionhandbook/6alternatives
andadjunctstobloodtransfusion/64parenteraliron)

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