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Semin Thromb Hemost 2013; 39(02): 182-190
DOI: 10.1055/s-0032-1333541
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Approach to Patients with Bleeding Disorders Who Do Not Accept Blood-Derived Products

Aryeh Shander
1   Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
2   Departments of Anesthesiology, Medicine, and Surgery, Mount Sinai School of Medicine, New York, New York
,
Mazyar Javidroozi
1   Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey
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Publikationsdatum:
08. Februar 2013 (online)

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Abstract

Despite the widespread use of allogeneic blood components in clinical practice, there are patients in whom transfusion cannot be carried out for various reasons, including refusal of transfusions because of religious beliefs. The refusal of transfusion is not equivalent to refusal of medical treatment, and numerous options are available to effectively manage care without transfusions. The strategies are collectively called Bloodless Medicine and Surgery and share many similarities with Patient Blood Management, that is, application of evidence-based medical and surgical concepts designed to preserve patient's own blood to improve the outcomes of patients. The strategies involve obtaining advance directive and consent to determine what components and procedures are acceptable to the patient; preoptimizing the patient for early correction of treatable deficiencies (e.g., anemia, coagulopathy); minimizing blood loss (e.g., hemostatic agents, blood salvage); and improving physiologic responses to anemia. Using these approaches, it is possible to effectively manage patients, with outcomes comparable to patients who accept transfusions.

Keywords

blood transfusion - Bloodless Medicine - Patient Blood Management - anemia - hemoglobin
 

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