Evolution in alternatives to blood transfusion.

Exposure of patients to allogeneic blood transfusion can be minimized or avoided by the systematic use of multiple blood conservation techniques. Such strategies exploit appropriate combinations of drugs, technological devices, and surgical/medical techniques. It also demands an interdisciplinary team approach, combining medical, surgical, and other specialists who share a commitment to avoiding the use of allogeneic blood transfusion. Current utilization of technologies or techniques to reduce allogeneic blood transfusion is variable. A total of 1000 US hospitals reported that preoperative autologous blood donation (PAD) and cell salvage programs were widely (480%) available. However, while pharmaceutical agents such as aprotinin and erythropoietin were available in 61 and 43% of hospital respondents, these two agents were ‘never’ or ‘almost never’ utilized at 81 and 91% of the sites, respectively. Despite its worldwide approval in the surgical setting beginning in 1993, acceptance of exogenous erythropoietin (EPO) therapy as an alternative to blood transfusion has been slow. Notwithstanding recent improvements in blood safety, a finite risk of transfusion-transmitted infections remains, along with risks from new and unknown pathogens. Minimizing blood transfusion has therefore become a desirable goal in surgical procedures for all patients. This review will summarize strategies that utilize drugs, technological devices, and/or surgical/ medical techniques that comprise a growing armamentarium of alternatives to blood transfusion.