STRATEGIEN ZUR MINIMIERUNG DER FREMDBLUTGABE BEI ELEKTIVEN EINGRIFFEN

The risks associated with homologous blood transfusion necessitates the development of strategies for reducing the need for it. The most effective method is certainly preoperative donation of autologous blood, which leads to an increase in the absolute numbers of erythrocytes by the time surgery is performed. Depending on the type of preparation and storage, erythrocytes may be viable for between 49 days (liquid storage) and many years (deep frozen). By employing preoperative plasmapheresis, high-quality autologous fresh frozen plasma can be made available for use during surgery. Donation of autologous blood and plasmapheresis are preoperative measures that need to be organized. Another possibility is the use of a cell separator to recycle blood lost during surgery, and may be applied intra-operatively (aspiration from the surgical wound) or postoperative (drainage). Hemodilution has but little effect in reducing homologous blood requirements. Instead of the technically complex and time-consuming acute normovolemic hemodilution (ANH), the simpler hypervolemic alternative version (HHD) should be employed. Applying all the measures described above, an appreciable reduction in the need for homologous blood can be achieved. A prerequisite, however, is close cooperation between the surgeon and anaesthesiologist.