Técnicas de ahorro de sangre en cirugía ortopédica

La cirugía ortopédica está asociada con frecuencia a la necesidad de transfusión de sangre homóloga, con los consiguientes riesgos que ello conlleva. En la actualidad se resalta la importancia de la disminución tanto de la transfusión como de la sobretransfusión en este tipo de cirugía. Dicho objetivo se puede alcanzar con el empleo de diversas técnicas de ahorro de sangre, que incluyan la potenciación del uso de sangre antóloga de métodos para disminuir el sangrado perioperatorio. La máxima eficacia para disminuir la necesidad de transfusión de sangre homóloga se deriva de la combinación de varias técnicas de ahorro, como son los programas de autotransfusión, la hipotensión controlada y el empleo de nuevos fármacos como eritropoyetina o aprotinina; todo ello sin olvidar la importancia de establecer unos criterios restrictivos, en consonancia con las directrices más actuales en este sentido, en el momento de indicar la necesidad de una transfusión sanguínea.Technique in orthopaedic surgery requires frequently transfusion of homologous blood which entails several risks. Nowadays, the importance of the decrease of both transfusion and overtransfusion has been proposed for this type of surgery. This aim can be reached by using different blood saving techniques including either the use of antologous blood or methods to minimize perioperative bleeding. The highest efficacy in order to diminish homologous blood transfusion combines several savings techniques as autotransfusion programs, controlled hypotension, and the use of new drugs such as erytropoyetin and aproinin. Restrictive criteria have to be established according to the more recent guidelines for blood transfusion

Intraoperative transfusion practices in Europe

Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger-mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)-based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (SD)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold