title: Bloodless medicine: current strategies and emerging treatment paradigms.
abstract: BACKGROUND
  Advances in our understanding of the risks associated with allogeneic blood transfusions (ABTs) and the growing number of patients who wish to avoid ABTs have led to the emergence of new treatment paradigms for "bloodless" medicine and surgery.
  
  
  METHODS
  Here, we review prior studies and summarize current strategies for bloodless care used at our institution. We advocate three basic principles: 1) diagnosing and aggressively treating anemia, 2) minimizing blood loss from laboratory testing and invasive procedures, and 3) identifying and managing bleeding diatheses. Anemia is treated with erythropoiesis-stimulating agents as well as iron, folate, and B12 when indicated. Low-volume phlebotomy tubes are used for laboratory testing. Autologous blood salvage is used for childbirth and surgical patients who have the potential for substantial bleeding.
  
  
  RESULTS
  Although there have been few retrospective studies and no prospective studies to guide management, prior studies suggest that outcomes for surgical patients managed without ABTs are comparable to those of historic controls.
  
  
  CONCLUSIONS
  Given the emerging evidence that patients who avoid ABTs do as well if not better than patients who accept ABTs, further efforts are needed to determine whether all patients could benefit from bloodless strategies. Bloodless approaches in selected patients could reduce risks, improve outcomes, and decrease costs for all patients.
authors.affiliation: Department of Medicine (Hematology), the, Baltimore, Maryland. lresar@jhmi.edu.|Department of Oncology, the, Baltimore, Maryland. lresar@jhmi.edu.|Institute for Cellular Engineering, the, Baltimore, Maryland. lresar@jhmi.edu.
authors.forename: Linda M S
authors.initials: LM
authors.lastname: Resar
authors.affiliation: Department of Surgery, the, Baltimore, Maryland.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
authors.affiliation: Department of Medicine (Hematology), the, Baltimore, Maryland.
authors.forename: Talal Nael
authors.initials: TN
authors.lastname: Almasri
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, and the, Baltimore, Maryland.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Dackiw
authors.affiliation: Department of Medicine (Hematology), the, Baltimore, Maryland.|Department of Pathology (Transfusion Medicine), The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, and the, Baltimore, Maryland.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
mesh_terms: D000740:Anemia / Q000628:therapy; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods*; D006801:Humans; D014184:Transplantation, Homologous