Bloodless clinical strategies for management of severe anaemia and hemorrhage
Authors:
J. Slipac
Authors‘ workplace:
Canadian Medical s. r. o., Brno
Published in:
Prakt. Lék. 2021; 101(5): 240-250
Category:
Reviews
Overview
Over the years, complex clinical strategies have been developed for managing patients who wish bloodless medical care, with an aim to minimize blood loss, conserve autologous blood, enhance haematopoiesis, and augment tolerance of anaemia. In this review, we discuss effective strategies in the setting of perioperative management, acute blood loss, trauma, and pregnancy. Under such approaches, patients with extremely low haemoglobin levels have survived and recovered without receiving allogeneic blood. Additionally, the valuable experience gained from bloodless care has paved the way to develop the concept of Patient Blood Management as a standard care to benefit all patients, and not only those for whom blood is not an option.
Keywords:
Hemorrhage – anaemia – bloodless clinical strategies – Patient Blood Management
Sources
1. Besen BA, Gobatto AL, Melro LM, et al. Fluid and electrolyte overload in critically ill patients: an overview. World J Crit Care Med 2015; 4(2): 116–129.
2. Beverina I, Razionale G, Ranzini M, et al. Early intravenous iron administration in the Emergency Department reduces red blood cell unit transfusion, hospitalisation, re-transfusion, length of stay and costs. Blood Transfus 2020; 18(2): 106–116.
3. Bienstock JL, Eke AC, Hueppchen NA. Postpartum hemorrhage. N Engl J Med 2021; 384(17): 1635–1645.
4. Blatný J, Bláha J, Cvachovec K, a kol. Diagnostika a léčba život ohrožujícího krvácení u dospělých pacientů v intenzivní a perioperační péči. Československý mezioborový doporučený postup. Anest Intenziv Med 2017; 28: 263–269.
5. Blatný J. Krvácení a jeho léčba – (nejen) hematologický problém. Interní Med 2009; 11(3): 120–122.
6. CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 2019; 394(10210): 1713–1723.
7. WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389(10084): 2105–2116.
8. Feiner JR, Finlay-Morreale HE, Toy P, et al. High oxygen partial pressure decreases anemia-induced heart rate increase equivalent to transfusion. Anesthesiology 2011; 115(3): 492–498.
9. Franchini M, Franchi M, Bergamini V, et al. The use of recombinant activated FVII in postpartum hemorrhage. Clin Obstet Gynecol 2010; 53(1): 219–227.
10. Georgiou C, Inaba K, DuBose J, et al. Optimizing outcomes in the Jehovah’s witness following trauma: special management concerns for a unique population. Eur J Trauma Emerg Surg 2009; 35(4): 383.
11. Girardis M, Busani S, Damiani E, et al. Effect of conservative vs conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA 2016; 316(15): 1583–1589.
12. Johnson-Arbor K, Verstraete R. Bloodless Management of the anemic patient in the emergency department. Ann Emerg Med 2021; S0196-0644(21)00515-1.
13. Kandane-Rathnayake RK, Isbister JP, Zatta AJ, et al. Australian and New Zealand Haemostasis Registry Steering Committee. Use of recombinant activated factor VII in Jehovah’s Witness patients with critical bleeding. ANZ J Surg 2013; 83(3): 155–160.
14. Klein AA, Bailey CR, Charlton A, et al. Association of Anaesthetists: Anaesthesia and peri-operative care for Jehovah’s Witnesses and patients who refuse blood. Anaesthesia 2019; 74(1): 74–82.
15. Kromker M, Lauscher P, Kertscho H, et al. Anemia tolerance during normo-, hypo- and hypervolemia. Transfusion 2017; 57(3): 613–621.
16. Kudela M, Pilka R, Dzvincuk P, et al. Bloodless surgery and gynecological patients among Jehovahs Witnesses. Čes. Gynekol. 2021; 86(2): 110–113.
17. Lasocki S, Pène F, Ait-Oufella H, et al. Management and prevention of anemia (acute bleeding excluded) in adult critical care patients. Ann Intensive Care 2020; 10(1): 97.
18. Liu Y, Li X, Che X, Zhao G, Xu M. Intraoperative cell salvage for obstetrics: a prospective randomized controlled clinical trial. BMC Pregnancy Childbirth 2020; 20(1): 452.
19. Lošťák J, Gallo J, Večeřa M, a kol. Lokální aplikace kyseliny tranexamové u TEP kyčle snižuje krevní ztráty a spotřebu krevních transfuzí. Acta Chir Orthop Traumatol Cech 2017; 84(4): 254–262.
20. Marinakis S, Van der Linden P, Tortora R, et al. Outcomes from cardiac surgery in Jehovah’s Witness patients: experience over twenty – one years. J Cardiothorac Surg 2016; 11(1): 67.
21. Matsunaga S, Takai Y, Seki H. Fibrinogen for the management of critical obstetric hemorrhage. J Obstet Gynaecol Res 2019; 45(1): 13–21.
22. Muñoz C, Aletti F, Govender K, et al. Resuscitation after hemorrhagic shock in the microcirculation: targeting optimal oxygen delivery in the design of artificial blood substitutes. Front Med (Lausanne) 2020; 7: 585638.
23. Muñoz M, Acheson AG, Auerbach M, et al. International consensus statement on the peri-operative management of anaemia and iron deficiency. Anaesthesia 2017; 72: 233–247.
24. Muñoz M, Acheson AG, Bisbe E, et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures. Anaesthesia 2018; 73(11): 1418–1431.
25. Naumann DN, Beaven A, Dretzke, et al. Searching for the optimal fluid to restore microcirculatory flow dynamics after haemorrhagic shock: a systematic review of preclinical studies. Shock 2016; 46(6): 609–622.
26. Neef V, Vo L, Herrmann E, et al. The association between intraoperative cell salvage and red blood cell transfusion in cardiac surgery – an observational study in a patient blood management centre. Anaesthesiol Intensive Ther 2021; 53(1): 1–9.
27. Nguyen TN, Boyd ME. Bloodless management of postpartum hemorrhage and Jehovah’s Witnesses. J Obstet Gynaecol Can 2019; 41(6): 743–744.
28. Pařízek A, Binder T, Bláha J, a kol. Diagnostika a léčba peripartálního život ohrožujícího krvácení. Česko-slovenský mezioborový konsenzus. Čes. Gynekol. 2018; 83(2): 151–158.
29. Porter SB, White LJ, Osagiede O, et al. Tranexamic acid administration is not associated with an increase in complications in high-risk patients undergoing primary total knee or total hip arthroplasty: A retrospective case-control study of 38,220 patients. J Arthroplasty 2020; 35(1): 45–51.e3.
30. Resar LM, Frank SM. Bloodless medicine: what to do when you can’t transfuse. Hematology Am Soc Hematol Educ Program 2014; 2014: 553–558.
31. Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013; 17(10): 1–79.
32. Sentilhes L, Sénat MV, Le Lous M, et al. Groupe de recherche en obstétrique et gynécologie. Tranexamic acid for the prevention of blood loss after cesarean delivery. N Engl J Med 2021; 384(17): 1623–1634.
33. Shander A, Brown J, Licker M, et al. Standards and best practice for acute normovolemic hemodilution: evidence-based consensus recommendations. J Cardiothorac Vasc Anesth 2020; 34(7): 1755–1760.
34. Shander A, Goodnough LT. Management of anemia in patients who decline blood transfusion. Am J Hematol 2018; 93(9): 1183– 1191.
35. Shander A, Javidroozi M, Gianatiempo C, et al. Outcomes of protocol-driven care of critically ill severely anemic patients for whom blood transfusion is not an option. Crit Care Med 2016; 44(6): 1109–1115.
36. Shander A, Javidroozi M, Naqvi S, et al. An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion. Transfusion 2014; 54 (10 Pt 2): 2688–2695.
37. Shander A, Javidroozi M. Blood conservation strategies and the management of perioperative anaemia. Curr Opin Anaesthesiol 2015; 28(3): 356–363.
38. Scharman CD, Burger D, Shatzel JJ, et al. Treatment of individuals who cannot receive blood products for religious or other reasons. Am J Hematol 2017; 92(12): 1370–1381.
39. Slipac J. Bezkrevní medicína. 2. aktualizované vydání. Praha: Triton 2011.
40. Slipac J. Evropská příručka osvědčených postupů Patient Blood Management. Prakt. Lék. 2017; 97(5): 206–213.
41. Slipac J. Patient Blood Managment – Proč? Praha: Triton 2020.
42. Slipac J. Předoperační anemie: výskyt, příčiny, následky, diagnostika a léčba. Prakt. Lék. 2018; 98(3): 99–103.
43. Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 2019; 23(1): 98.
44. Ševčíková S, Durila M, Vymazal T. Vliv infuzních roztoků na krevní srážlivost. Anest Intenziv Med 2018; 29(5): 258–264.
45. Taeuber I, Weibel S, Herrmann E, et al. Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression. JAMA Surg 2021; 156(6): e210884.
46. Tan GM, Guinn NR, Frank SM, Shander A. Proceedings from the Society for advancement of blood management Annual meeting 2017: Management dilemmas of the surgical patient – when blood is not an option. Anesth Analg 2019; 128(1): 144–151.
47. van Der Linden P, James M, Mythen M, Weiskopf RB. Safety of modern starches used during surgery. Anesth Analg 2013; 116(1): 35–48.
48. Varela JE, Gomez-Marin O, Fleming LE, Cohn SM. The risk of death for Jehovah’s Witnesses after major trauma. J Trauma 2003; 54(5): 967–972.
49. Vasques F, Kinnunen EM, Pol M, et al. Outcome of Jehovah’s Witnesses after adult cardiac surgery: systematic review and meta-analysis ofcomparative studies. Transfusion 2016; 56(8): 2146–2153.
50. Wu WW, Zhang WY, Zhang WH, et al. Survival analysis of intraoperative blood salvage for patients with malignancy disease: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2019; 98(27): e16040.
Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2021 Issue 5
Most read in this issue
- Selected risk factors for stroke
- Bloodless clinical strategies for management of severe anaemia and hemorrhage
- Is the public sufficiently aware about the importance of pertussis vaccination in adulthood?
- Acromegaly – under-diagnosed disease with serious complications