"Patient blood management" in orthopaedic surgery

Abstract

Orthopaedic and trauma surgical procedures (OTS) can lead to significant blood losses and acute postoperative anaemia, which in many cases requires allogeneic blood transfusions (ABT). The clinical, economic and logistical disadvantages of ABT have promoted the development of multidisciplinary and multimodal programs generically known as Patient Blood Management (PBM) programs, which have as their objective to reduce or eliminate the need for ABT and improve clinical outcomes. These programs are supported by the implementation of four groups of perioperative measures: (1) use of restrictive transfusion criteria; (2) stimulation of erythropoiesis; (3) reduction of bleeding; and (4) autologous blood transfusion. In this article, a review is presented of the effectiveness, safety and recommendations of applicable strategies in OTS, as well as the barriers and requirements to the development and implementation of PBM programs in this surgical specialty.

Keywords: Agentes antifibrinolíticos; Agentes estimuladores de la eritropoyesis; Allogeneic blood transfusion; Anaemia; Anemia; Antifibrinolytic agents; Autologous blood transfusion; Cirugía ortopédica; Erythropoiesis stimulating agents; Gestión integral del paciente; Hierro; Iron; Orthopedic surgery; Patient Blood Management; Pérdida quirúrgica de sangre; Surgical Blood Loss; Transfusión de sangre alogénica; Transfusión de sangre autóloga.