American Society of Anesthesiologists (ASA) has developed practice guidelines for blood component therapy. ASA Recommendations for blood transfusion are:
Recommendation: Red Blood Cells
The organization concluded that:
1. Transfusion is rarely indicated when the hemoglobin concentration is greater than 10 g / dL and is almost always indicated when less than 6 g / dL, especially when acute anemia.
2. Does hemoglobin concentration was (6-10 g / dL) requiring transfusion of red blood cells must be based on patients' risk of complications of inadequate oxygenation.
3. Not recommended using only the trigger hemoglobin for patients who fail to fix all the physiological factors important in surgery that could affect oxygenation.
4. If the right circumstances, the use of preoperative autologous blood, intraoperative and postoperative, acute hemodilution normovolemik, deliberate hypotension, and drugs can be beneficial.
5. Indications for autologous transfusion of red blood cells may be better than allogeneic red blood cells because of the risk of disease transmission is lower.
The guidelines emphasize the importance of determining patients' risk of complications related to inadequate oxygenation, a concept that emphasized more recently.
A simplified guide will be very helpful. For example, with the help Habibi et al, following guidelines suggested that administration of a single unit of PRC will increase the hematocrit of 3-5%.
Blood Transfusion Indications are:
o Blood loss> 20% of blood volume when more than 1000 ml.
o Hemoglobin <8 g / dL
o Hemoglobin <10 g / dL with severe disease (eg, emphysema, ischemic heart disease)
o Hemoglobin <10 g / dL with autologous blood
o Hemoglobin <12 g / dL and ventilator dependent
The consideration of oxygen transport capacity is more important than an increase in intravascular volume. Hence the authors emphasize the importance of hemoglobin or hematocrit determination. Prompts many blood banks, autologous blood is better than allogeneic blood.
Autologous vs. allogeneic blood Blood
Surprisingly, there is the notion that autologous blood is safer than allogeneic blood (for example, from the risk of infection). Therefore, autologous blood program can be dihapuskan.Satu example of such research are patients hysterectomy.
Kanter et al found that 25 of the 140 patients who donate blood should be transfused back to him while of the 123 patients who did not donate their own blood to be transfused only 1. Therefore, it was concluded that preoperative autologous blood better be abolished because it increases the risk of allogeneic blood transfusion.
They further argue that autologous blood is not at risk. One of 16,000 autologous blood donation have reactions severe enough to require hospitalization.
In fact, some of the complications associated with autologous blood transfusion on the list below:
1. Anemia
2. Preoperative myocardial ischaemia of anemia
3. The wrong units (1:100,000)
4. Blood transfusions are more often
Suggestions for autologous blood transfusion restriction does not include immunosuppression (see later discussion) or the spread of infections in allogeneic blood. For example, from 1986 to 1991, there were 182 reported transfusion-related distress to the FDA, 29 (16%) of them are caused by bacterial contamination. 10 cases were reported enterokolitika Yersinia infections. Almost all with allogeneic blood, although two patients also received autologous blood, so it was concluded that allogeneic blood is also quite risky.
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