Blood conservation and transfusion in anaesthesia
Over the last three decades, avoidance of allogeneic transfusion in order to decrease adverse events within the recipient has become a part of clinical care. Although the main driver was an avoidance of transfusion-transmitted disease, other immunological consequences have been noted, and it is widely regarded as desirable to avoid the use of allogeneic component transfusion unless there is an essential physiological need. Of course this attempt at decreasing allogeneic blood component use has a potentially beneficial effect of blood component supply, leading to decreased use within the surgical specialties, while allowing increased use in clinical cases where there is currently no alternative to the transfusion of allogeneic components, such as those cases who have received chemotherapy and marrow suppression. The development of an array of techniques and treatments to decrease dependence of blood component transfusion has led to a care pathway that attempts to treat preoperative anaemia, minimize operative blood loss, and withhold allogeneic transfusion in the postoperative period according to clinical need. Many questions remain about the appropriate level of haemoglobin depending upon the comorbidities suffered by the patient, which is why patient blood management has gained popularity, as each patient deserves an individual care plan according to need.