PHARMACOLOGICAL APPROACHES TO REDUCE PERIOPERATIVE TRANSFUSION REQUIREMENTS IN THE AGED

Although iron deficiency is undoubtedly the commonest cause of anaemia even in elderly people, the aetiology is not always clear owing to va rious underlying diseases. Correction of anaemia is sometimes needed b efore surgery. The use of drugs that may influence blood coagulation, such as aspirin (acetylsalicylic acid), should be checked. Perioperati ve allogenic blood transfusion can often be avoided by the use of auto logous blood and improved surgical techniques. Autologous blood donati ons are preferable in cases of planned surgery. Epoetin (recombinant h uman erythropoietin) in combination with iron supplementation facilita tes the donation of autologous blood, even in elderly patients. Anothe r method of avoiding allogenic blood transfusion is the collection and reuse of the blood a patient sheds in operations. During and/or after surgery, may haemostatic agents are available. Moreover, recent devel opments in gene engineering have enabled the utilisation of recombinan t cytokines and coagulation factors. Further work remains to be done t o define the proper use of these agents.