From Bloodless Surgery to Patient Blood Management

Mt Sinai J Med
Aryeh Shander, MD,1,2 Mazyar Javidroozi, MD, PhD,1 Seth Perelman,
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Safety and efficacy concerns of allogeneic blood
transfusions and their impact on patient outcomes
and associated staggering costs and restricted supply
have fueled the quest for other modalities and
strategies to reduce use of blood components. Patient
blood management focuses on multidisciplinary and
multimodal preventive measures to reduce or obviate
the need for transfusions and ultimately to improve
the clinical outcomes of patients. Patient blood management
strategies can be applied at every stage of
care to surgical and nonsurgical patients, and they
Address Correspondence to:
Aryeh Shander
Department of Anesthesiology
Englewood Hospital and Medical Center
350 Engle Street, Englewood, NJ 07631
Email: aryeh.shander@ehmc.com
generally fall under one of these three categories
(the so-called pillars of blood management): optimizing
hematopoiesis and appropriate management
of anemia, minimizing bleeding and blood loss, and
harnessing and optimizing physiological tolerance of
anemia through employing all available modalities
while treatment is initiated. Several tools and modalities
are available to address each of these pillars.
Examples include hematinic agents, systemic and topical
hemostatic agents, autotransfusion, and bloodsparing
perfusion and surgical techniques. Additionally,
changes in practice of clinicians (eg, adherence
to restrictive, evidence-based transfusion strategies
with emphasis on physiologic indications for transfusion,
minimization of iatrogenic blood loss, and
adequate planning) play an important role in patient
blood management. Emerging evidence supports that
appropriate use of these strategies as part of a multimodal
program is a safe and effective way of reducing
allogeneic transfusions and improving patient outcomes.