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Lo ngại về chi phí và an toàn truyền máu allogenic, bao gồm cả nguy cơ nhiễm virus và ức chế miễn dịch, đã dẫn đến sự cải tiến trong và cách tiếp cận mới để bảo tồn máu, bao gồm cả sự phát triển của tiêu chuẩn thực hành truyền máu và cải tiến trong thực hành phẫu thuật. | Perioperative Blood Management Practices in Elective Orthopaedic Surgery E. Michael Keating MD and John B. Meding MD Abstract Concern about the cost and safety of allogenic blood transfusion including the risk of viral infection and immunosuppression has led to refinements in and new approaches to blood conservation including the development of transfusion practice standards and improvements in surgical practice. Preoperative autologous blood collection the use of hemostatic agents perioperative blood salvage and the use of recombinant human erythropoietin epoetin alfa to stimulate erythropoiesis have contributed to decreased use of allogenic blood services. Development of appropriate blood management strategies to help reduce or eliminate exposure to allogenic blood requires a preoperative assessment of the likelihood of transfusion and of the risks as well as costs associated with conservation and replacement options. The informed selection of alternatives based on preoperative assessment of hematologic status estimated blood loss and sources for blood replacement may enhance blood management practices in major elective orthopaedic surgery. J Am Acad Orthop Surg 2002 10 393-400 The safety of surgical blood management practices is critically important because of the potential risks of transfusion reactions immunosuppression and disease transmission associated with use of allogenic blood. One response to these concerns has been increased use of autologous blood. Approximately 15 years ago less than 5 of patients participated in preoperative autologous donation PAD before elective surgery.1 Today 50 to 75 of patients opt for PAD primarily because of concerns about transfusion-transmitted human immunodeficiency virus HIV and hepatitis. Other blood management techniques have been developed including the use of hemostatic agents perioperative blood salvage and the use of recombinant human erythropoietin epoetin alfa to stim ulate erythropoiesis. Because of the .
