Multimodal strategy for reduction of homologous transfusions in craniomaxillofacial surgery

The transfusion of homologous blood carries well-known risks that have prom pted efforts to develop alternative techniques. Such measures are of partic ular interest to patients undergoing elective procedures. A total of 204 pa tients, out of 1470 patients who consecutively underwent major craniomaxill ofacial procedures under general anesthesia over a two-year period. were en rolled in a prospective protocol to reduce homologous transfusion requireme nts when a bleed loss in excess of 500 ml was anticipated. The data were co mpared with the results of a retrospective control group (n=2890) covering major procedures during the previous four years, when blood-saving measures were applied occasionally, but not based on a global strategy. Techniques for the reduction of homologous transfusions were acute normovolemic hemodi lution, controlled moderate hypotension, cell saver and predeposit autologo us bleed. In addition, preoperative administration of human recombinant ery thropoietin was introduced during the last year of the study. These techniq ues were applied individually or in combination, depending on contraindicat ions specific for each technique, using invasive monitoring in order to mai ntain intraoperative hemodynamic stability. The goal of this study was to e xamine the extent to which homologous transfusions may be reduced with the systematic application of transfusion-sparing techniques. Of 204 patients q ualifying for the transfusion-sparing protocol, 30 received homologous tran sfusions. In comparison to the control group, utilization of transfusion-sp aring techniques had doubled. The overall reduction in the use of homologou s transfusions was highly significant, When acute normovolemic hemodilution , controlled moderate hypotension and the cell saver were used in combinati on, a greater reduction in homologous transfusions was achieved than with t he use of either a single modality or combination of any two. No transfusio ns were required in patients pretreated with erythropoietin.