[Preoperative strategy for homologous blood salvage and peri-operative erythropoietin].
The amount of transfused blood is related to blood loss calculated for the specific type of surgical procedure, transfusion hematocrit trigger and patient's red blood cell mass on the day before surgery. To optimise the benefit/cost and benefit/risk ratios of blood transfusion, a correct prescription must be done in accordance with the patient's red blood cell mass and surgical blood loss. Indeed, there is a clear need to define the appropriate uses of blood management methods and to seek new methods of improving perioperative blood management. The number of moderately anaemic patients undergoing surgery is currently thought to be 20%. Where transfusion requirements are estimated at two to three blood units, as for instance in the most common types of orthopaedic surgery, preoperative haemoglobin is the key factor governing transfusion needs. In this case, the simplest approach is to prescribe Epoetin Alfa subcutaneous at a dose of 600 IU/kg/week starting three weeks before the surgery. In addition, it is important in all cases to give concomitant iron supplements. Concomitant use of other methods to decrease allogeneic blood requirements is of no value. Obviously, the higher the haematocrit the day prior to surgery, the higher the patient's RBC mass and the greater the patient's permitted blood loss, decreasing the transfusion trigger. In this way, allogeneic blood loss is reduced, but without the need for the patient to attend the blood transfusion center and to undergo laboratory screening and testing of donated blood, and without the risk of inducing preoperative anaemia compared with sequential autologous blood donation. But, to optimise the benefit/cost ratio, we try to define precisely the patient populations likely to benefit from preoperative erythropoietin. Using different examples, management is proposed with algorithms.
Rosencher
N
N
Département d'anesthésie-réanimation, Hôpital Cochin-Saint-Vincent-de-Paul, Paris, France.
Woimant
G
G
Ozier
Y
Y
Conseiller
C
C
D000740:Anemia / Q000628:therapy; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics; D001804:Blood Transfusion, Autologous / Q000191:economics; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005069:Evaluation Studies as Topic; D006400:Hematocrit; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods*; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D009985:Orthopedics / Q000191:economics / Q000379:methods; D011292:Premedication / Q000191:economics; D011300:Preoperative Care / Q000379:methods*; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D007501:Iron