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An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery
R Slappendel, Ris Dirksen, Erik W G Weber and Dick van der Schaaf
Departments of Anaesthesiology, Orthopedics, Sint Maartenskliniek, Njimegen, Anaesthesiology, Academic Hospital Maastricht, Maastricht, The Netherlands
Acta Orthop Scand 2003; 74 (5):569-575
Aim: To revise the transfusion guidelines at the St Maartens Clinic.
Method: A relational database of 28 861 patients was used to find circumstances surrounding a high incidence of allogenic transfusion.
Results: Circumstances were found to be failure to follow guidelines, pre-operative use of non-selective NSAIDs, low preoperative Hb, failure to retrieve blood and high cut-off calues for allogenic transfusion.
Conclusion: Recommended measures to reduce allogenic blood transfusion include Iron and EPO treatment and exclusion of non-selective NSAIDS pre-operatively, predonation, normothermia during the operation, Aprotinin and intra- as well as post-operative blood salvage. Bellovac ABT is recommended for patients where blood loss is expected to be 1 litre or more.
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