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Protocol

Anemia Treatment and Erythropoietin therapy Guidelines

Protocol based on scientific evidence for the non-transfusional treatment of anemia through the appropriate use of iron and erythropoietin.

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Options/alternatives to bloodtransfusions

They exist. They are safe. They are efficient. They save lives. It can be the only option to treat anemia and save a life.

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Transfusion safety

The best blood a patient can receive in a transfusion is their own blood. The blood with it`s own DNA

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Blood safety recommendations who:

“Reduce the necessity of transfusions..." "...Simple alternatives to transfusion are safer and wost-effective”

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Options/alternatives to blood transfusions

They exist. They are safe. They are efficient. They save lives. It can be the only option to treat anemia and save a life.

Transfusion safety

The best blood a patient can receive in a transfusion is their own blood. The blood with it`s own DNA

Blood safety recommendations who:

“Reduce the necessity of transfusions…
…simple alternatives to transfusion are safer and cost-effective”

Welcome to the Bloodless

Background: Blood transfusions are currently one of the most performed medical procedures in the world. However, the medical literature shows a relationship between the use of allogeneic (donated) blood and greater complications, including, greater mortality. Worldwide, there is a deficiency in medical knowledge about transfusion practice.

performed medical procedures in the world. However, the medical literature shows a relationship between the use of allogeneic (donated) blood and greater complications, including,  greater mortality. Worldwide, there is a deficiency in medical knowledge about transfusion practice.

Strategies for the conservation (management) of the patient’s blood (Pacient Blood Management – PBM), in the area of Transfusion Medicine, have shown, through impactful scientific publications, a better clinical outcome, with reduced morbidity and mortality for patients and costs for the health system. The real and marked shortage of blood stocks, especially during the COVID-19 pandemic, has encouraged the URGENT search for therapeutic options for blood transfusions.

Objectives
1. To change the current transfusion practice, through the application of scientifically safe and effective PROTOCOLS for the TREATMENT OF ANEMIA and MANAGEMENT OF BLEEDING without the use of allogeneic blood, based on the scientific evidence of modern medicine.

2. To help blood banks SAVE their main HEMOCOMPONENTS (red blood cells, plasma and platelets)

Perguntas e Respostas

According to the World Health Organization (WHO) anemia is defined as the level of hemoglobin below 13.0 g/dL for men, below 12.0 g/dL for non-pregnant women and below 11.0 g/dL for pregnant women. In children the WHO defines anemia as the hemoglobin below 11.0 g/dL for the age of 6-60 months age, below 11.5 g/dL for the age of 5-12 years old, and below 12.0 g/dL for adolescents of 12-15 years old.

No. Fortunately, today we have several therapeutic options for saving the life of a patient with severe anemia. These involve clinical and surgical strategies for treating anemia and/or preventing blood loss. To achieve this it is required equipment, machinery, techniques and specific drugs.

Medicine does not provide this answer. In 1942, Dr. John Lundy believed that a person with hemoglobin of 10 g/dL or less, would be at risk of death, therefore, he proposed blood transfusion to all patients who achieved such a hemoglobin level. Unfortunately, this idea lasted for over half a century. After year 2000, the risk of death came to be considered for patients with hemoglobin

below 8 g/dL.

Fortunately, medical knowledge evolved greatly over the past decade, and one of the major discoveries in transfusional practice was that human beings not just tolerate 8 g/dL of moglobin, but much lower levels than this. Recent researches show survival of patients even in severe anemia condition.

Dr. Graffeo reported that his patient reached level of 1.9 g/dL of hemoglobin and he did not die.

Dr. Liana Araújo reported that one of her patients survived even after target a hemoglobin level of 1.4 g/dL.

Another case described in abstracts published in the Brazilian Archives of Cardiology (January 2015) showed a patient who achieved 2.9 g/dL of hemoglobin and requiring hemodialysis.

For many doctors these values would be incompatible with life.

Nonetheless, all of these survived without the use of blood and blood components.

However, to highlight even more that there is an individual tolerance of every human being to critical levels of blood in the body JianQiang Dai has reported the survival of his patient after he has reached 0.7 g/dL of hemoglobin.

(Learn more on the SCIENTIFIC EVIDENCE section)

There are countless options. We going to quote the main options with the impact to reduce and/or prevent a blood transfusion.

1 – Tolerance to anemia.. The patient tolerates anemia, the doctor cooperates with the patient in tolerating anemia. This tolerance is individual. Learn more with the second question of this section.
2 – Medicines for treating anemia.. Ferrous sulphate, folic acid, vitamin B12, erythropoietin.

3 – Medicines of systemic usage (intravenous) to stop bleeding and prevent blood transfusion:: tranexamic acid, epsilon aminocaproic acid,vasopressin, desmopressin acetate, vitamin K, activated recombinant factor VII, coagulation factor VIII concentrated, prothrombin complex concentrated, human fibrinogen concentrated, human recombinant factor XIII. Dosages of
these drugs are found at the article “Therapeutic options to minimize allogeneic blood transfusions and their adverse events in cardiac surgery: Systematic review”.

4 – Topical usage medicines to stop the bleeding and avoid blood transfusion: oxidized cellulose hemostat for the wound’s compression; fibrin glue/sealant; fibrin or platelets gel; hemostatic collagen; gelatin foam/sponges; calcium alginate.

5 – Equipment that avoids blood transfusion (cell saver):: This equipment recovers the patient’s blood that otherwise would be lost during the surgery. The interesting fact to consider is that this recovered blood has the patient’s DNA. This blood can be reused and does not represent a hemotoxin (“foreign body”). This is a true blood’s “recycling”. This is the best blood that a patient could receive in a transfusion: HIS OWN BLOOD.

The intraoperative autotransfusion is an excellent alternative to allogeneic blood, primarily because the benefits such as: availability of fresh blood, decreased postoperative complications, reduction of number of days of hospitalization and associated infections, reduction of death and decreases the homologous blood demand (donated blood).

6 – Acute normovolemic hemodilution.. It consists of the withdrawing of one, two, three or more bags of the patient’s blood at the beginning of the surgery,

being replaced by crystalloid and/or colloid solutions such as plasma volume expanders, in order to maintain normovolemia. This blood will be at the surgeon’s disposal to be used in the appropriate time, usually at the end of surgery. In case of any bleeding in surgery, we will have less blood loss, as it will be diluted. This stored blood has the patient’s DNA without the risk of immunological reactions.

7 – Surgical techniques.. It is also a treatment option for reducing the use of blood transfusions. This strategy involves meticulous hemostasis, a hypotensive anesthesia and mild hypothermia to prevent loss of blood, and consequently, less consumption of blood. 

8 – Avoid excessive blood samples.Withdrawing of blood three, four, five or more times in one day, from the same patient, only to follow a routine or some
arbitrary protocol of certain intensive care unit (ICU), for sure will cause an iatrogenic anemia and consequently result in an also iatrogenic blood transfusion.Therefore, excessive blood withdrawal causes anemia, and as most doctors will not tolerate anemia, the result is a transfusion.

Therefore, always ask your doctor if this withdrawal will change the conduct, that is, if it will guide further treatment. Otherwise, the withdrawn blood will only contribute to worsen the clinical condition.

9 – Use of pediatric tubes for collecting blood. The more blood is withdrawn from a patient, especially when he is hospitalized, the worse will be his health condition. What is proposed is to collect a minimum of blood needed to carry out essential laboratory tests. The objective of this strategy is to avoid unnecessary blood loss and hence avoid blood transfusions. Ask your doctor about this.

10 – Early oxygen therapy/Supplemental oxygen. Tolerance to anemia can be increased by ventilating the patient with a high fraction of inspired oxygen (FiO2). Ventilate with 100% oxygen results in rapid increase in arterial oxygen content, ensuring tissue oxygenation even with very low hemoglobin (severe anemia) and it proves to be an important strategy for reducing allogeneic transfusion.

11– Other therapeutic options are found in the article” Therapeutic options to minimize allogeneic blood transfusions and their adverse events in cardiac surgery: Systematic review “,, publicado na Rev Bras Cir Cardiovasc. published by Rev Bras Cir Cardiovasc. 2014;29(4):606-21, available 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

We can say that all types of pathologies in any health center in the world have been treated using one or more therapeutic options to the blood transfusions. The more options and/or alternative we use to avoid the use of blood, the greater the possibility of saving the patient without the use of a blood transfusion.

Among serious and complex surgeries already performed with these strategies include: heart transplantation, heart retransplantation, bone marrow transplant, kidney transplant, liver transplant, aortic aneurysm repair surgery, heart surgeries (coronary artery bypass grafting, valve replacement, simple and complex congenital heart disease repairs), benign or malignant tumor resection surgeries (cancer), orthopedic surgery, neurological surgeries and several other surgeries.

“The good physician treats the disease; the great physician treats the patient who has the disease.”.

— William Osler (Canadian physician, 1849-1919)

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Protocol

Anemia Treatment and Erythropoietin therapy Guidelines

Protocol based on scientific evidence for the non-transfusional treatment of anemia through the appropriate use of iron and erythropoietin.

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This calculator shows in a simple and objective way, the good cost-Benefit ratio.