title: Avoiding allogenic blood transfusions in endoscopic angiofibroma surgery.
abstract: BACKGROUND
  Surgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures. Therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature revealed very few case reports. This study investigated the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA).
  
  
  METHODS
  JNA is a rare vascular nasal tumour and the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to the endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.
  
  
  RESULTS
  Homologous blood transfusion could be avoided in all cases. Postoperative monitoring revealed transient bacteraemia in two cases where the leukocyte filter was not used, but no evidence of septicaemia.
  
  
  CONCLUSIONS
  Perioperative cell saver and autologous blood transfusion in endonasal JNA surgery is safe. Homologous blood transfusion can be avoided by using this technique. The use of cell salvage allows for single stage surgery without the need to abandon surgery due to excessive blood loss and its future use is promising.
authors.affiliation: Division of Otolaryngology, University of Cape Town, Cape Town, South Africa. hisham7070@yahoo.com.
authors.forename: Hisham
authors.initials: H
authors.lastname: Wasl
authors.affiliation: Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.
authors.forename: Jessica
authors.initials: J
authors.lastname: McGuire
authors.affiliation: Division of Otolaryngology, University of Cape Town, Cape Town, South Africa.
authors.forename: Darlene
authors.initials: D
authors.lastname: Lubbe
mesh_terms: D000293:Adolescent; D018322:Angiofibroma / Q000523:psychology / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000523:psychology; D002648:Child; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033221:Jehovah's Witnesses / Q000523:psychology*; D008297:Male; D009055:Mouth; D009303:Nasopharyngeal Neoplasms / Q000523:psychology / Q000601:surgery*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult