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There are multiple therapeutic resources to reduce or avoid allogenic blood transfusion (other person’s blood). These options involve clinic strategies with medicine and/or specific equipment to treat the patient with anemia and/or blood coagulation disorder (for instance, low platelet). On the other hand, there are also surgical strategies with evidences to reduce blood loss by the patient during surgery. One can also save the use of blood components, already short in the blood banks, by specific measures to treat the patient to be more tolerant to the anemic situation.

Using only OPTIONS and ALTERNATIVES to allogeneic blood transfusions (donated blood), MD Antonio Alceu dos Santos and TEAM (PhD Jose Pedro da Silva) conducted the WORLD’S FIRST CARDIAC RESTRANSPLATATION in a 6 year old child, without the use of homologous blood (blood from another person). The highlight of this surgery’s success is due to the importance of a multidisciplinary planning of intensive care (surgeon, clinic, anesthesiologist and intensive therapy doctors) focused on saving the patient’s blood through a program known as PBM (Patient Blood Management), which aims to use all the clinical and surgical strategies to avoid the use of allogeneic blood through a transfusion.
The full case was published in Brazilian Journal of Cardiovascular Surgery (2012):
http://www.scielo.br/pdf/rbccv/v27n2/v27n2a23.pdf

Another UNIQUE case of SERIOUS ANEMIA in the WORLD treated with options and alternatives to allogeneic blood transfusions (donated blood) was the surgery of repair of an aneurysm of an ascending aorta, aortic valve replacement by bioprosthesis, myocardial revascularization in a patient with chronic renal failure with requiring hemodialysis. Due to several complications in the postoperative period, the patient progressed with severe anemia (2.9g/dL hemoglobin – Normal > 13.0g/dL ), but he survived without the use of conventional treatment for anemia with homologous blood transfusion (blood from another person). It was possible to save the patient’s life with other simple resources and effective substitutes instead of donated blood.
The case was published in CARDIOLOGY RESEARCH (2016):
http://www.cardiologyres.org/index.php/Cardiologyres/article/view/463

The main options and/or alternatives with impact to reduce blood transfusion are:

1 – Tolerate anemia..
In the anemia situation, two parts are involved: PHYSICIAN and PATIENT. It is already scientific knowledge that the patient tolerates anemia. But, unfortunately, many doctors still do not know this. If both know this fact, many blood transfusions can be avoided. Medicine does not say to which point the doctor shall tolerate anemia, this is individual. See question 2 in QUESTIONS & ANSWERS.

2 – Medications to treat anemia..
Ferrous sulphate, folic acid, B12 vitamin, erythropoietin, darbepoietin and CERA (continuous erythropoietin activator) are the main ones. There are others in final phase of worldwide liberation which play the role of the blood when transporting oxygen: Hemopure, Hemolink, Oxygent.

3 – Medications of systemic usage (intravenous) to stop bleeding and avoid blood transfusion:: Tranexamic acid, aminocaproic epsilon acid, vasopressin, combined estrogens, octreotide, somatostatin, desmopressin acetate (DDAVP), K vitamin (phytomenadione), activated recombined factor VII, factor VIII coagulation concentrate, prothrombin complex concentrate, human
fibrinogen concentrate, human recombined factor XIII.

4 – Medications of topic usage to stop bleeding and avoid blood transfusions: oxidized cellulose haemostatic for wound compression; fabric adhesive/fibrin glue/sealers; fibrin or platelets gel; haemostatic collagen; jelly foam/sponge; topic buffering of thrombin or soaked with thrombin; vegetal origin polysacharides; calcium alginate.

5 – Equipment/machines which avoid blood transfusion:: It is a machine capable of recovering the patient’s blood that would be lost during surgery. What is interesting is that this recovered blood has DNA from the patient themselves. It can be reused and is not a homotoxin (“foreign body”). When not recovered, unfortunately, it goes to the trash can together with gauze and compresses. It is a real blood recycling.

This is the best blood a patient could receive in a transfusion: their OWN BLOOD.

Intraoperative self-transfusion is an excellent alternative to allogenic blood, mainly due to the benefits, like: fresh blood immediate disposal, postoperative complications diminish, reduction of days of staying and associated infections, reduction of death, as well as diminishing the need of homologous blood (bags).

The cost of this procedure is almost the same as the price of one or two blood bags, when taking into account all the activities involved in blood transfusion.

6 – Acute normovolemic hemodilution. This is one of the simplest and cheapest options for treatment to avoid or diminish the necessity of transfusion. It consists in taking off one, two, three or more blood bags from the patient in the beginning of the surgery, being replaced by crystalloids and/or colloids solutions as plasma volume expanders, to keep the normovolemia. This blood will be at the surgeon disposal to be used at an appropriated moment, normally at the end of the surgery. If any bleeding occurs during surgery, there will be less blood loss, since it will be diluted. This recovered and saved blood has the patient DNA, without risks of immunologic reactions. The cost of this procedure is of approximately U$20.00 (twenty dollars) or R$60,00 (sixty reais), which would be the cost of two empty blood collecting bags.

7 – Surgical techniques. This strategy involves a meticulous hemostasis (acute surgical techniques to stop bleeding) and a hypotensive anaesthesia. Allowing the patient to have their blood pressure a little lower, the lowest tolerated level, will result in less blood loss, because the blood leaking pressure to outside the body during bleeding will be minor. Another surgical technique to avoid or reduce the consumption of allogenic blood consists in using anaesthesia with moderated hipotermy (to cool the patient during surgery).

8 – Avoid excessive blood collections. This is the simplest option to avoid blood transfusion. Nevertheless, putting it into action seems to be something difficult and with no value. This was noticed with the act of washing hands by doctors after examining a patient, as well. It is also a simple procedure, but there is much rejection to put it into action in order to avoid infection. Taking blood three, four, five or more times in one day only, from the same patient, only to follow a routine or some arbitrary protocol of a determined Intensive Care Unit (ICU), will, surely, cause an iatrogenic anemia, and, consequently, result in a blood transfusion also iatrogenic.. Therefore, excessive collections of blood generates anemia; as most doctors do not tolerate anemia, the result is a transfusion. Therefore, always ask your doctor if this collection will change the conduct, this is to say, will lead to a new treatment. Otherwise, the blood taken oaken blood will only to worsen the medical condition.

9 – Using small tubes to collect blood. This is also a simple option or alternative to avoid the usage of allogenic blood (from other person). Science agrees that the more blood is taken from one patient, mainly when hospitalized, the worst it will be for their health. What is proposed is to take the minimum necessary blood to run the essential lab tests. In order to do this, in many cases, one can use the small pediatric tubes to perform collection in adult patients. The result of this strategy means avoiding an unnecessary blood loss and, consequently, to avoid blood transfusions. Practicing this is to adopt modern medicine which also save lives without using blood through transfusion. Ask your doctor about this.

10 – Early oxygen therapy/ Additional oxygen. Tolerance to anemia can be increased by ventilating the patient with a high inspired fraction of oxygen
(FiO2). While maintaining normovolemia (normal circulating volume), hyperoxid ventilation (offer 100% oxygen) can be considered a salvation therapy when facing an important bleeding associated with severe acute anemia with risk of Ventilating with 100% oxygen results in fast increase in the continent of arterial oxygen, assuring oxygenation of tissues even with very low hemoglobin
(severe anemia) and shows an important strategy to reduce allogenic transfusion.

11 – Outras opções de tratamento are found in the article “Therapeutic options to minimize allogeneic blood transfusions and their adverse effects in cardiac surgery: a systematic review”,, published in Rev Bras Cir Cardiovasc. 2014;29(4):606-21, and available in PORTUGUESE and in ENGLISH in the following link:

http://www.rbccv.org.br/article/2321/Therapeutic-options-to-minimize-allogeneic-blood-transfusions-and-their-adverse-effects-in-cardiac-surgery–a-systematic-review

Therefore, there are multiple therapeutic options to reduce the number of transfused patients and the quantity of blood and its components given to each one.

Figure 3
Schematic representation of acute hemodilution [Click on image to enlarge]

Figure 4. Schematic representation of intraoperative blood recovery
Schematic representation of acute hemodilution [Click on image to enlarge]

ASK YOUR DOCTOR!

 

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