Blood conservation in surgery

The aim of all efforts to reduce the need of allogeneic blood transfusions is to avoid associated risks. There should particularly be a favourable eff ect according to the rate of transfusion-transmitted virus infections and i mmunological side-effects. The acceptance of an individually adjusted lowes t haematocrit level and the minimisation of intra-operative blood loss by t he application of optimal surgical techniques are among the most essential strategies to reduce or even avoid allogeneic blood transfusions. In additi on the following interventions are generally accepted: Preoperative autologous blood donation, where appropriate supported by eryt hropoietin Preoperative haemodilution, where appropriate supported by erythropoietin Intra- and postoperative blood salvage Topical or systemic pharmacologic interventions to accelerate haemostasis Controlled hypotension Efficacy and indication of the different measures always depend on the indi vidual circumstances of the specific patient. Therefore one should develop an individual approach for every case. In this context the most important s ubjects are an optimal coordination and if required an appropriate combinat ion of the discussed methods. Algorithms which preoperatively allow approxi mate calculation of expected transfusion need may be a meaningful tool to f acilitate blood conservation planning. However, at the same time one must c onsider that all strategies to reduce allogeneic transfusion needs are also associated with particular risks. Therefore one has to weigh carefully the pros and cons prior to their application, including the possible alternati ve of allogeneic transfusion in one's decision making process.