title: Therapeutic options to minimize allogeneic blood transfusions and their adverse effects in cardiac surgery: a systematic review.
abstract: BACKGROUND
  Allogeneic blood is an exhaustible therapeutic resource. New evidence indicates that blood consumption is excessive and that donations have decreased, resulting in reduced blood supplies worldwide. Blood transfusions are associated with increased morbidity and mortality, as well as higher hospital costs. This makes it necessary to seek out new treatment options. Such options exist but are still virtually unknown and are rarely utilized.
  
  
  OBJECTIVE
  To gather and describe in a systematic, objective, and practical way all clinical and surgical strategies as effective therapeutic options to minimize or avoid allogeneic blood transfusions and their adverse effects in surgical cardiac patients.
  
  
  METHODS
  A bibliographic search was conducted using the MeSH term "Blood Transfusion" and the terms "Cardiac Surgery" and "Blood Management." Studies with titles not directly related to this research or that did not contain information related to it in their abstracts as well as older studies reporting on the same strategies were not included.
  
  
  RESULTS
  Treating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, reducing routine phlebotomies, utilizing less traumatic surgical techniques with moderate hypothermia and hypotension, meticulous hemostasis, use of topical and systemic hemostatic agents, acute normovolemic hemodilution, cell salvage, anemia tolerance (supplementary oxygen and normothermia), as well as various other therapeutic options have proved to be effective strategies for reducing allogeneic blood transfusions.
  
  
  CONCLUSIONS
  There are a number of clinical and surgical strategies that can be used to optimize erythrocyte mass and coagulation status, minimize blood loss, and improve anemia tolerance. In order to decrease the consumption of blood components, diminish morbidity and mortality, and reduce hospital costs, these treatment strategies should be incorporated into medical practice worldwide.
authors.affiliation: Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, SP, Brasil.
authors.forename: Antônio Alceu dos
authors.initials: AA
authors.lastname: Santos
authors.affiliation: Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, SP, Brasil.
authors.forename: José Pedro da
authors.initials: JP
authors.lastname: Silva
authors.affiliation: Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luciana da Fonseca da
authors.initials: Lda F
authors.lastname: Silva
authors.affiliation: Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, SP, Brasil.
authors.forename: Alexandre Gonçalves de
authors.initials: AG
authors.lastname: Sousa
authors.affiliation: Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, SP, Brasil.
authors.forename: Raquel Ferrari
authors.initials: RF
authors.lastname: Piotto
authors.affiliation: Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, SP, Brasil.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Baumgratz
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D001793:Blood Preservation / Q000379:methods; D001803:Blood Transfusion / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008488:Medical Illustration; D057725:Operative Blood Salvage / Q000379:methods; D065227:Transfusion Reaction
chemical_list: D006490:Hemostatics