Scottish Intercollegiate Guidelines Network (SIGN).
Blood Sparing Strategies
Preoperative Autologous Blood Donation
D: Preoperative autologous blood donation should be offered only when it is possible to guarantee admission and operative dates.
B: Preoperative autologous blood donation can be used to reduce allogeneic blood exposure, although it does increase the total number of transfusion episodes.
C: Preoperative autologous blood donation can be used safely in elderly populations with diverse comorbidities.
C: Preoperative autologous blood donation should be targeted to men who present with haemoglobin 110 to 145 g/l and women who present with haemoglobin 130 to 145 g/l.
Erythropoietin
B: Erythropoietin use should be targeted to patients aged under 70 years who are scheduled for major blood losing surgery and who have a presenting haemoglobin <130 g/l.
D: Erythropoietin can be used to prepare patients with objections to allogeneic transfusion for surgery that involves major blood loss.
Combination of Preoperative Autologous Blood Donation and Erythropoietin
B: In fit patients undergoing major surgery, erythropoietin can be used in combination with autologous blood collection to reduce allogeneic transfusion.
B: In fit patients undergoing major surgery, erythropoietin can be used to obtain multiple autologous red cell donations while maintaining an adequate day of surgery haemoglobin.
Cardiac Surgery
Aprotinin and Antifibrinolytic Drugs
B: The use of aprotinin or tranexamic acid is recommended for patients undergoing cardiac surgery which carries a high risk of transfusion (e.g. repeat cardiac operations, multiple valve replacements, thoracic aortic operations, patients on preoperative aspirin therapy and procedures with anticipated long bypass times).
Cell Salvage
C: Reinfusion of washed shed mediastinal blood may be used to reduce allogeneic transfusion in cardiac surgery.
Orthopaedic Surgery
Aprotinin
B: Aprotinin may be considered to reduce blood loss in hip and knee arthroplasties but its use should be restricted to procedures with an increased risk of high blood loss (e.g., bilateral and revision) and to circumstances when other blood conservation techniques are not appropriate (e.g., treatment of Jehovah's Witnesses).
Tranexamic Acid
B: Tranexamic acid can be used to reduce blood loss and transfusion requirements in patients undergoing knee replacement surgery, when other blood conservation techniques are inappropriate and where major blood loss is anticipated.
Cell Salvage
D: Unwashed postoperative salvage using drains should be considered in patients in whom a postoperative blood loss of between 750 ml and 1,500 ml is anticipated (e.g., bilateral joint replacement).
B: Washed intraoperative salvage should be considered in patients in whom an intraoperative blood loss of more than 1,500 ml is anticipated (e.g., major pelvic, spinal or non-infected revision surgery).
B: In orthopaedic surgery, cell salvage using either unwashed or washed red blood cells may be considered as a means of significantly reducing the risk of exposure to allogeneic blood.
See also:
Summary Guidelines
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