6Alternatives to allogeneic blood transfusions
Section snippets
Tolerance of acute normovolaemic anaemia
The initial treatment of intraoperative blood loss always consists in the maintenance of normovolaemia by the infusion of crystalloid (3:1) and colloidal solutions (1:1). This acellular fluid replacement implies the dilution of the cell mass remaining in the vasculature (haemodilution), resulting in a dilutional anaemia (acute normovolaemic anaemia).
In the context of alternatives to allogeneic blood transfusion, the term ‘anaemia tolerance’ is used to refer to the patient's physiological
Autologous transfusion techniques
Autologous transfusion techniques are generally intended to replace as many allogeneic RBC transfusions as possible by (re)transfusion of autologous blood. Autologous blood is either harvested a couple of weeks before (preoperative blood donation, PAD) or immediately before surgery (acute normovolaemic haemodilution, ANH). The concept of intraoperative cell salvage (ICS) implies the collection and reprocessing of shed blood for autologous retransfusion.
Artificial oxygen carriers
An attractive alternative to allogeneic RBCs consists in synthetic blood substitutes (artificial oxygen carriers), which can be applied independently of blood-group typing or infectious risks. Currently, there are two types of artificial oxygen carrier under experimental and clinical investigation: (1) synthetically manufactured perfluorocarbons (PFC), and (2) haemoglobin-based oxygen carriers (HBOCs), i.e., solutions based on isolated human or bovine haemoglobin.61
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