title: Clinical and Surgical Strategies for Avoiding or Reducing Allogeneic Blood Transfusions.
abstract: Blood transfusions have still been used as a standard therapy to treat severe anemia. Current evidences point to both excessive allogeneic blood consumption and decreased donations, which result in reduced stocks in blood banks. Several studies have increasingly suggested a more restrictive transfusion practice for blood products. Currently, a number of autologous blood conservation protocols in surgeries have been noted. We report a case of severe anemia with 2.9 g/dL hemoglobin, which was successfully handled without using the standard therapy to treat anemia with hemotransfusions. Such a case of severe anemia condition resulted after the patient was submitted to ascending aortic aneurism repair, valvar aortic replacement, reimplantation of right coronary ostium, followed by a coronary artery bypass grafting and several postoperative complications. The main clinical and surgical strategies used in this case to avoid blood transfusions were acute normovolemic hemodilution, intraoperative blood cell salvage, and meticulous hemostasis, beyond epsilon-aminocaproic acid, desmopressin, prothrombin complex concentrate, human fibrinogen concentrate, factor VIIa recombinant, erythropoietin and hyperoxic ventilation.
authors.affiliation: Hospital Beneficencia Portuguesa de Sao Paulo, Rua Maestro Cardim, 560, 2º Andar, Sala 22, Bela Vista, Sao Paulo, SP, CEP: 01323-900, Brazil.
authors.forename: Antonio Alceu
authors.initials: AA
authors.lastname: Dos Santos
authors.affiliation: Hospital Beneficencia Portuguesa de Sao Paulo, Rua Maestro Cardim, 769, Bloco I, 2º Andar, Sala 202, Bela Vista, Sao Paulo, SP, CEP: 01323-900, Brazil.
authors.forename: Jose Francisco
authors.initials: JF
authors.lastname: Baumgratz
authors.affiliation: Hospital Beneficencia Portuguesa de Sao Paulo, Rua Maestro Cardim, 769, Bloco I, 2º Andar, Sala 202, Bela Vista, Sao Paulo, SP, CEP: 01323-900, Brazil.
authors.forename: Jose Henrique Andrade
authors.initials: JH
authors.lastname: Vila
authors.affiliation: Hospital Beneficencia Portuguesa de Sao Paulo, Rua Martiniano de Carvalho, 864, Sala 1004, Bela Vista, Sao Paulo, SP, CEP: 01323-900, Brazil.
authors.forename: Rodrigo Moreira
authors.initials: RM
authors.lastname: Castro
authors.affiliation: Hospital Beneficencia Portuguesa de Sao Paulo, Rua Maestro Cardim, 560, 2º Andar, Sala 22, Bela Vista, Sao Paulo, SP, CEP: 01323-900, Brazil.
authors.forename: Rodrigo Freire
authors.initials: RF
authors.lastname: Bezerra
keywords: Anemia; Blood preservation; Blood transfusion; Bloodless medical procedures; Cardiac surgical procedures; Surgical procedures