title: Strategies to reduce the use of blood products:  a European perspective.
abstract: OBJECTIVE
  Anemia is the most common hematologic problem preoperatively. In itself it compromises the outcome of surgical patients, and additionally results in more frequent allogeneic red blood cell (RBC) transfusions which again independently compromise patient outcome. In elective cardiac surgery as well as in other surgical specialties the use of a patient blood management program will minimize the exposure to blood products, lead to a cost reduction and improve patient's outcome. The aim of this review is to discuss the rationale for patient blood management, explain patient blood management in detail including modern and future transfusion strategies.
  
  
  RESULTS
  The risk for allergenic RBC transfusions is increased by preoperative anemia. The adverse outcome in recipients of RBC transfusions has recently been shown to be caused rather than only associated with RBC transfusions. In Jehovah's witnesses undergoing cardiac surgery patient blood management programs have been established effectively, demonstrating that it is possible to correct preoperative anemia and avoid RBC transfusions resulting in better outcomes.
  
  
  CONCLUSIONS
  Patient blood management strategies are based on an interdisciplinary multimodal approach including early preoperative recognition and treatment of anemic patients, surgical efforts to minimize blood loss, optimal perfusion strategies to reduce hemodilution and continuous assessment of the bleeding and coagulation status of patients as well as a restrictive volume management. This allows specific and goal-directed treatment of patients, preventing anemia in elective patients, optimizing patient's coagulation status early, minimizing exposure to blood products, reducing costs and improving patient's outcome.
authors: Institute of Anesthesiology, University Hospital and University of Zurich, Switzerland. oliver.theusinger@usz.ch
authors: Oliver M
authors: OM
authors: Theusinger
authors: Christian
authors: C
authors: Felix
authors: Donat R
authors: DR
authors: Spahn
mesh_terms: D000465:Algorithms; D000740:Anemia / Q000517:prevention & control / Q000628:therapy; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000379:methods; D006348:Cardiac Surgical Procedures; D017707:Erythrocyte Transfusion; D005060:Europe; D006801:Humans; D009017:Morbidity; D011300:Preoperative Care; D065227:Transfusion Reaction