Transfusion-free Surgery is a Treatment Plan for All Patients

AORN Journal, Nov, 1998 by Tricia Trovarelli, Barbara Kahn, Sharon Vernon

Erythropoietin has been approved by the FDA for use in patients undergoing orthopedic procedures. Its dose-dependent stimulation of red blood cells has become useful as an adjunct to endogenous erythropoiesis and autologous predonation.(51) Findings from several studies suggest that the administration of erythropoietin preoperatively may decrease the number of postoperative transfusions by stimulating erythropoiesis.(52) There is also a financial element to consider because there is a reduction in cost and complexity that accompanies preoperative autologous donation.

In a large, randomized study conducted in Canada on total hip replacement candidates, it was shown that erythropoietin administration before surgery decreased the need for postoperative transfusions.(53) Patients were given either erythropoietin 300 U/kg subcutaneously for 10 days preoperatively and three days postoperatively or a placebo substance.(54) The mean number of RBC transfusions in the erythropoietin group was 0.52, compared with 1.14 in the placebo group, and only 23% of patients who received erythropoietin required transfusion, compared with 44% in the placebo group (P = 0.007).(55)

Blood management in elective surgical procedures must be directed toward reduction of surgical blood loss and implementation of blood preservation measures. Surgical technique and anesthesia can significantly affect surgical blood loss. Preoperative autologous donation and the intraoperative use of autotransfusion cell washers are proven techniques of blood salvage in procedures involving increased blood loss. Postoperative reinfusion of wound drainage can be successful, but patients must be monitored carefully.

Preoperative administration of erythropoietin safely and effectively increases RBC mass in patients who are unable to participate in preoperative autologous donation programs. Bloodless surgery centers and a network of hospital liaison committees have facilitated the advancement of elective surgical procedures in patients who refuse transfusion of blood products. Patients must be educated as to the risks and benefits of any therapy, if they are to make informed choices about medical management of their condition.

NOTES

(1.) N Shute, "Hepatitis C: Silent killer," U.S. News & World Report 124 (June 22, 1998) 60-66.

(2.) Ibid.

(3.) P I Tartter, Immunologic Aspects of Blood Transfusion (Boca Raton, Fla: R G Landes, 1992) 29-46.

(4.) M Spry, "Updates of bloodless centers in the United States and the world," speech presented at the First National Seminar for Bloodless Medicine and Surgery, Cleveland, 7 Oct 1995.

(5.) G Church, No Man's Blood (Fullerton, Calif: Institute of Bloodless Medicine and Surgery, 1982).

(6.) D A Ott, D A Cooley, "Cardiovascular surgery in Jehovah's Witnesses: Report of 542 operations without blood transfusion," Journal of the American Medical Association 238 (September 1977) 1256-1258.

(7.) Ibid.

(8.) L S Brunner, D S Suddarth, Textbook of Medical-Surgical Nursing, sixth ed (Philadelphia: J B Lippincott Co, 1988) 664.