Blood Transfusion In Elective Surgery Research Articles

Anemia and Transfusions in Patients Undergoing Surgery for Cancer

Preoperative, operative, and postoperative factors may all contribute to high rates of anemia in patients undergoing surgery for cancer. Allogeneic blood transfusion is associated with both infectious risks and noninfectious risks such as human errors, hemolytic reactions, transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, and transfusion-related immune modulation. Blood transfusion may also be associated with increased risk of cancer recurrence. Blood-conservation measures such as preoperative autologous donation, acute normovolemic hemodilution, perioperative blood salvage, recombinant human erythropoietin (epoetin alfa), electrosurgical dissection, and minimally invasive surgical procedures may reduce the need for allogeneic blood transfusion in elective surgery. This review summarizes published evidence of the consequences of anemia and blood transfusion, the effects of blood storage, the infectious and noninfectious risks of blood transfusion, and the role of blood-conservation strategies for cancer patients who undergo surgery. The optimal blood-management strategy remains to be defined by additional clinical studies. Until that evidence becomes available, the clinical utility of blood conservation should be assessed for each patient individually as a component of preoperative planning in surgical oncology.

PHP35 ANALYZING THE CLINICAL, ECONOMIC, AND POLICY IMPACT OF INDIVIDUALIZED MEDICINE BASED ON GENETIC INFORMATION (“PHARMACOGENOMICS“)

Despite recent advances in blood screening techniques, transfusions are not risk-free. Therefore, screening for viral and bacterial infections as well as other, newlyemerging agents continues to attract attention in the medical and health policy communities. At the same time, governments and other decision-making bodies increasingly use cost-effectiveness analyses to justify (or reject) allocation of limited financial resources to new technologies. OBJECTIVES: To assess the cost-effectiveness of commonly employed blood safety interventions, and compare those cost effectiveness levels with other accepted injury prevention measures. METHODS: Using MEDLINE, we conducted a literature review on the cost-effectiveness of various transfusionrelevant blood safety interventions. We identified 16 studies (published between 1993 and 2000) of blood safety interventions that evaluated their economic benefit as either a cost per QALY or cost per life year (LY). These interventions included several testing procedures for transfusion donations (such as viral screening procedures for HIV) and medical procedures (such as autologous blood transfusion in elective surgery and epoietin therapy). Most technologies related to testing and processing blood donations are now standard practice in the USA and Europe. RESULTS: A majority of blood safety interventions had cost-effectiveness ratios greater than $200,000 per QALY or LY. Fewer than 35% had cost-effectiveness ratios less than $50,000 per QALY or LY. CONCLUSIONS: Many blood safety and injury prevention regulations have cost-effectiveness ratios well above $50,000 per QALY. Although $50,000 per QALY is recognized as the standard threshold value against which medical technologies are evaluated, many commonly accepted blood safety interventions and injury prevention measures have much higher cost effectiveness ratios. This indicates that society places a high value on the risks prevented or reduced by such measures and suggests that innovative blood safety technologies should be assessed against a higher cost-effectiveness threshold.

Autologous blood transfusion for elective surgery.

Between September 1983 and June 1985, 336 patients were assessed by the Autologous Blood Transfusion Service; 267 men, mean age, 65 (range, 16-75) years, and 40 women, mean age, 63 (range, 40-70) years, participated in the programme (29 patients were excluded as unsuitable). Orthopaedic and vascular surgery accounted for 80% of the cases. Complications were minor even in this elderly group. Surgical and transfusion details for a one-month period were studied retrospectively. Of the surgical cases that required crossmatched blood, 50% were for "emergency" and "burn" surgery, and 50% for elective surgery. Forty-five per cent of this latter group were unsuitable as autologous donors, 21% had participated in the autologous blood transfusion programme, and an additional 34% were deemed to be suitable donors. The realistic upper limits of our autologous blood transfusion programme were determined as being 55% of elective cases that require crossmatched blood. To be efficient an autologous blood transfusion service must be incorporated into an existing homologous blood transfusion service and must complement, rather than replace, homologous blood transfusion.