Elective Coronary Artery Bypass Graft Surgery Using Reduced Homologous Blood Transfusion

Abstract

Substantial blood loss following by anemia may be a common event during the pre-, peri- and postoperative period of cardiac surgery. Despite the goodness and life-saving of allogenic blood transfusion, it is not accepted by healthcare professionals due to the transmission of viral infections and increased risk of morbidity and mortality. This study aimed to review blood conservation strategies in use leading reduction of homologous blood transfusion, to evaluate the hemoglobin threshold for elective surgeries, to define transfusion trigger point in practice. The finding showed that a decrease in homologous blood transfusion using transfusion management is well accepted worldwide. Various blood conservation strategies could be mitigated anemia by applying hemostatic agents, hemoglobin substitutes, blood salvage systems, the reduction of blood loss related to diagnostic testing, prescription of erythropoietin and restrictive blood transfusion triggers in hospitalized patients. Strategies such as blood loss reduction, hemostatic agents and erythropoietin result in higher hemoglobin levels had some limitations and not been found to reduce blood transfusions or to improve clinical practice and outcomes. Other blood management ways in the surgical procedure include perioperative blood loss reduction using diathermy, hypotensive anesthesia, tourniquet, aminocaproic acid and desmopressin as the anti-fibrinolytic agents. Lowering the hemoglobin threshold considered as the way to decrease morbidity or mortality rate among the patients without vigorous cardiac disease. Therefore, it is crucial to plan prior to a predicted occurrence in the case of anemia or blood loss including elective surgery, pregnancy, and chemotherapy, to organize early screening and management of anemias via the bloodless medicine programs in the clinical setting.