Surgical techniques to reduce blood loss and transfusion need

Multiple approaches are available to the surgeon who wishes to reduce patient exposure to the risks of allogeneic blood transfusion. These range from transfusion of the patient's own blood through red cell salvage and reinfusion to the use of drugs such as iron and erythropoietin to restore red cell mass. Transfusion need in surgery is clearly tied to blood loss; it follows that reduction of operative blood loss should minimize the need for transfusion. All surgeons are taught according to Halstedian principles of gentle tissue handling and anatomic dissection, techniques designed in part to reduce intraoperative bleeding. Our increased knowledge about the risks of allogeneic blood has prompted many surgeons to analyze and to revise standard approaches to surgical procedures and/or to develop innovative techniques in an attempt to reduce or eliminate blood loss and transfusion. This brief report will focus on such recent efforts.