Alternatives to blood transfusion

Abstract

The use of alternatives to allogeneic blood continues to rest on the principles that blood transfusions have inherent risks, associated costs, and affect the blood inventory available for health-care delivery. Increasing evidence exists of a fall in the use of blood because of associated costs and adverse outcomes, and suggests that the challenge for the use of alternatives to blood components will similarly be driven by costs and patient outcomes. Additionally, the risk-benefit profiles of alternatives to blood transfusion such as autologous blood procurement, erythropoiesis-stimulating agents, and haemostatic agents are under investigation. Nevertheless, the inherent risks of blood, along with the continued rise in blood costs are likely to favour the continued development and use of alternatives to blood transfusion. We summarise the current roles of alternatives to blood in the management of medical and surgical anaemias.

Figure 1

Patient blood management These recommendations apply in the perisurgical period enable treating physicians to have the time and methods to provide patient-centred and evidence-based patient blood management to minimise allogeneic blood transfusions. Modified from Goodnough and Shander, by permission of the American Society of Anesthesiologists.

Figure 2

Algorithm for the detection, assessment, and management of preoperative anaemia SF=serum ferritin. TSAT=transferrin saturation. Modified from Goodnough and colleagues, by permission of Oxford Journals.