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[Consensus conference. Saving blood: which are still the doubts and the problems?]
G C Caroli1, B Borghi, G Pappalardo
1I Servizio di Anestesia e Rianimazione, IRCCS Istituti Ortopedici Rizzoli di Bologna.
Minerva Anestesiologica
|May 1, 1994
Summary
This consensus conference established guidelines for blood conservation strategies, including autologous transfusion and careful volemic replacement. Key findings focus on acceptable hemoglobin levels and effective blood salvage techniques for patient safety.
Area of Science:
- Anesthesiology
- Transfusion Medicine
- Critical Care Medicine
Background:
- Guidelines for blood conservation strategies were developed through a consensus conference.
- Patient consent is mandatory for both autologous and homologous transfusions.
- Volemic replacement protocols differentiate between crystalloid and colloid solutions based on blood loss percentage.
Framework:
- Severe isovolemic hemodilution (hematocrit < 20%) requires adjustments in drug dosages.
- Hemoglobin levels around 9 g/dL post-phlebotomy may be acceptable without cerebrovascular or coronary disease.
- Phlebotomy is permissible with hemoglobin levels of 10 g/dL (hematocrit 30%).
Implementation:
- Salvaged blood requires centrifugation, washing, and microfiltration before reinfusion.
- Red blood cells can be reinfused within 8 hours post-sedimentation and microfiltration.
- Techniques like predeposit, hemodilution, and recovery are effective when combined with meticulous bleeding control.
Implications:
- Postoperative hemoglobin levels around 7 g/dL may be tolerated in the late period (days 3-6) if well-managed.
- Controlled aspiration, drainage monitoring, and compression bandages aid in managing postoperative bleeding.
- These guidelines aim to optimize patient blood management and reduce transfusion risks.