Need For Allogeneic Blood Transfusion Research Articles

The Role of Tranexamic Acid (TXA) In Spine Surgery for Patients with Comorbidities in Basra/Iraq

Background: Blood loss occurs frequently and remains a challenge in spinal surgery. As significant intra and postoperative hemorrhage negatively affects patient outcomes by increasing coagulopathy, postoperative hematoma, and anemia. The need for allogenic blood transfusions can lead to potential transfusion reactions and infections, in addition to increasing long-term mortality rates. Although there are many randomized control trials and meta-analysis investigating the role of tranexamic acid (TXA), we could not find any study that investigated the role of TXA in patients with medical comorbidities. Therefore, tackling the role of TXA in patients with single or multiple comorbidities is of valuable outcome to our locality as most of the patients have indeed associated comorbidities. Objectives: to investigate the role of tranexamic acid in decreasing perioperative blood loss in patients with multiple comorbidities as compared to otherwise healthy individuals. Patients and methods: A single center randomized control trial. We included patients that were about to undergo simple decompressive surgeries for lumbar canal stenosis and fixation with decompression for spondylolisthesis. Patients were randomly categorized into cases (who received TXA) and controls who received NS. Patients then were subcategorized according to comorbidities and types of surgeries. Intraoperative blood loss was calculated using the suction drain and the gauze while the post operative bleeding was calculated using the drain output. Results: There was 441.84 ml (49.6 %) decrease in intraoperative bleeding for patients who received TXA as compared to controls regardless the type of surgery and regardless the presence or absence of comorbidities. Hypertensive patients had 52.7 % reduction in intraoperative bleeding when received TXA, Diabetic patients showed 44.4 % reduction in bleeding, Obese patients showed 51.1% reduction and patients with multiple comorbidities showed 51% reduction in intraoperative bleeding while healthy individuals showed 38.9% reduction in intraoperative bleeding. Conclusion: TXA was even more effective in decreasing intraoperative bleeding in patients with multiple comorbidities as compared to healthy individuals.

PHARMACOLOGICAL INTERVENTIONS FOR THE PREVENTION OF BLEEDING IN PEOPLE UNDERGOING ELECTIVE HIP OR KNEE SURGERY: A COCHRANE SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Preoperative anaemia and intraoperative blood loss result in ∼90% of individuals being anaemic following hip and knee arthroplasty. Reducing blood loss offers the opportunity to improve outcomes and reduce the risk of transfusion and costs. This review's aim was to determine the effectiveness of drugs for preventing blood loss, and identify optimal dose, route, and timing of administration.Cochrane network meta-analysis of randomised controlled trials was conducted. Inclusion criteria: adults undergoing primary or revision elective hip or knee arthroplasty. Drugs studied: tranexamic acid (TXA), aprotinin, epsilon-aminocaproic acid, desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non-fibrin sealants. Primary outcomes: need for allogenic blood transfusion, all• cause mortality (within 30 days). Secondary outcomes: mean number of transfusion episodes, re-operation, length of hospital stay and adverse events (DVT, PE, CVA, MI).102 studies with 8418 participants. Trials included more women (63%). 47 studies (4398 participants) were included within the blood transfusion NMA. TXA given intra-articularly and orally at a total dose of greater than 3g pre-incision, intraoperatively and postoperatively ranked the highest, with anticipated absolute effect of 147 fewer transfusions per 1000 (53% chance ranking 1st) (relative risk(RR) 0.02, 95% credible interval(CrI) 0–0.31); moderate-certainty). Aprotinin (RR 0.59, 95%:CrI 0.36–0.86; low certainty evidence), fibrin (RR 0.86, CrI 0.25–2.93; very-low certainty) and EACA (RR 0.60, 95%:CrI 0.29–1.27; very-low certainty) were not shown to be as effective as TXA.TXA was the most effective drug for preventing bleeding in lower limb arthroplasty. Aprotinin and EACA were not as effective. Currently, the optimal dose, route and timing of administration of TXA is unclear. However, TXA given at higher doses and via mixed routes ranked higher in the treatment hierarchy. Oral TXA may be as effective as intavenous. There was no evidence of harm associated with higher doses of TXA.

Efficacy of intraoperative blood salvage and autotransfusion in living-donor liver transplantation: a retrospective propensity matched case-control study.

Liver transplantation (LT) may be associated with massive blood loss and the need for allogeneic blood transfusion. Intraoperative blood salvage autotransfusion (IBSA) can reduce the need for allogeneic blood transfusion. This study aimed to investigate the effectiveness of blood salvage in LT. Among 355 adult patients who underwent elective living-donor LT between January 1, 2019, and December 31, 2022, 59 recipients without advanced hepatocellular carcinoma received IBSA using Cell Saver (CS group). Based on sex, age, model for end-stage liver disease (MELD) score, preoperative laboratory results, and other factors, 118 of the 296 recipients who did not undergo IBSA were matched using propensity score (non-CS group). The primary outcome was the amount of intraoperative allogenic red blood cell (RBC) transfusion. Comparisons were made between the two groups regarding the amount of other blood components transfused and postoperative laboratory findings. The transfused allogeneic RBC for the CS group was significantly lower than that of the non-CS group (1,506.0 ml vs. 1,957.5 ml, P = 0.026). No significant differences in the transfused total fresh frozen plasma (FFP), platelets, cryoprecipitate, and estimated blood loss were observed between the two groups. The postoperative allogeneic RBC transfusion was significantly lower in the CS group than in the non-CS group (1,500.0 ml vs. 2,100.0 ml, P = 0.039). No significant differences in postoperative laboratory findings were observed at postoperative day 1 (POD1) and discharge. Using IBSA during LT can effectively reduce the need for perioperative allogeneic blood transfusions without causing subsequent coagulopathy.

Efficacy and safety of terlipressin infusion during liver surgery: a protocol for systematic review and meta-analysis

IntroductionLiver disease causes 2 million deaths annually, accounting for 4% of all deaths worldwide. Liver surgery is one of the effective therapeutic options. Bleeding is a major complication during liver...

Rational Transfusion in Clinical Practice: Walking the Tight Rope

Transfusion therapy has undergone a significant evolution from whole blood transfusions to highly specialized blood component therapy. There is enough evidence in the literature that estimates that half of the transfusions given to the patients were actually not required as their hemoglobin can be improved with the help of alternative methods. The introduction of patient blood management (PBM) marks a paradigm shift in clinical transfusion practice and anemia management, emphasizing a patient-centric approach. PBM strategies aim to preserve and improve the patient’s blood, thereby reducing the need for allogeneic blood transfusions. PBM strategies include treating anemia, correcting coagulopathy, and minimizing blood loss. Every healthcare facility should plan to implement PBM as a multidisciplinary and multi-professional program, requiring collaboration from clinicians, public health professionals, and hospital administration. Thus, PBM implementation requires a comprehensive business plan, evidence-based transfusion guidelines, education, and a clinical decision support system. Data acquisition, analysis, audits, and reports play a crucial role in continuously improving the healthcare system and enhancing patient safety.

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis.

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis.

Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension

Background: En bloc removal of the kidney with tumor thrombus excision in a multidisciplinary team remains the standard treatment for renal cell carcinoma (RCC) with tumor thrombus extension. In order to minimize the hemodynamic impact of the surgical blood loss, intraoperative cell salvage (IOCS) techniques can decrease the need for allogeneic blood and prevent blood transfusion related complications. Objective: In this article, we evaluated the safety of IOCS during radical nephrectomy with inferior vena cava thrombectomy under cardiopulmonary bypass with or without deep hypothermic circulatory arrest. Design and method: In this retrospective comparative multicenter analysis, clinical characteristics of 27 consecutive patients who underwent surgery with or without IOCS between 2012 and 2022 in three referral care units were collected into a database. The need for an allogenic blood transfusion (ABT) was also recorded, defined as any transfusion that occurred either intraoperatively or during the hospital stay. Results: The need for ABT in the cell saver arm was significantly smaller due to the reinfusion of rescued blood ( p < 0.015). In multivariate analysis, no cell saver usage was an independent predictor for complications ⩾3 Clavien 3a [odds ratio (OR) 18.71, 95% CI 1.056–331.703, p = 0.046]. No usage of IOCS was an independent predictor for a lower risk of death (OR 0.277, 95% CI 0.062–0.825, p = 0.024). During follow-up, patients who received salvaged blood did not experience an increased risk for developing local recurrence or distant metastases. Conclusion: Transfusion of autologous blood is safe and can be using during nephrectomy and thrombectomy for advanced RCC.

The role of acute normovolemic hemodilution in reducing allogeneic blood transfusion in glioblastoma surgery: a case–control study

BackgroundAcute normovolemic hemodilution (ANH) was first introduced in glioblastoma surgery, and its role in reducing allogeneic blood transfusion was investigated in this study.MethodsThis study enrolled supratentorial glioblastoma patients who received total resection. In the ANH group, the patients were required to draw blood before the operation, and the blood will be transfused back to the patient during the operation. The association between ANH and clinical features was investigated.ResultsSixty supratentorial glioblastoma patients were enrolled in this study, 25 patients were allocated in the ANH group, and another 35 patients were included in the control group. ANH dramatically reduced the need for allogeneic blood transfusion (3 [12%] vs 12 [34.3%], P = 0.049), and the blood transfusion per total of patients was dramatically decreased by the application of ANH (0.40 ± 1.15 units vs 1.06 ± 1.59 units, P = 0.069). Furthermore, ANH also markedly reduced the requirement of fresh frozen plasma (FFP) transfusion (2 [8%] vs 11 [31.4%], P = 0.030) and the volume of FFP transfusion per total of patients (32.00 ± 114.46 mL vs 115.71 ± 181.00 mL, P = 0.033). The complication rate was similar between the two groups.ConclusionsANH was a safe and effective blood conservation technique in glioblastoma surgery.

Ferric derisomaltose and Outcomes in the Recovery of Gynecologic oncology: ERAS (Enhanced Recovery After Surgery) (FORGE) – a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery

IntroductionIron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment...

Effects of intraoperative or postoperative administration of intravenous iron supplements on hemoglobin recovery in patients with total knee arthroplasty: A systematic review and meta-analysis.

The objectives of the researchers are as follows: First, to investigate whether intraoperative or postoperative administration of Intravenous (IV) iron supplements in patients undergoing primary total knee arthroplasty (TKA) can contribute to the hemoglobin recovery during the postoperative period (between 4 and 8 weeks after surgery). Second, to examine whether the administration of IV iron supplements during or immediately after TKA in patients undergoing primary TKA can reduce the need for allogenic blood transfusion during hospitalization. Articles published between January 1, 1990, and June 30, 2023 were searched in PubMed, Cochrane, and Embase. The population, intervention, comparison, and outcome of this study are as follows; Population: Patients undergoing primary total knee arthroplasty; Intervention: Administration of IV iron supplements during or immediately after surgery; Comparison: Non-administration of IV iron supplements; Outcome: Degree of hemoglobin recovery (between 4 and 8 weeks after surgery) and the need for blood transfusion during hospitalization. There was a statistically significant difference in the amount of change in hemoglobin between iron supplementation group and non-iron supplementation group. The effect size were -0.44 (95% confidence interval: -0.69 to -0.19, P value < .001) in all patients. This means that the amount of change in hemoglobin were significantly reduced in the iron supplementation group than in the non-iron supplementation group. There was a statistically significant difference for post-operative transfusion rate between 2 groups. The effect size were 0.28 (95% confidence interval: 0.10-0.81, P value = .02) in all patients. This means that the post-operative transfusion rate was significantly less in the iron supplementation group than in the non-iron supplementation group. The administration of IV iron supplements during or after TKA surgery increases hemoglobin recovery between 4 and 8 weeks after surgery and reduces the need for allogeneic blood transfusion during hospitalization.

Outcomes of direct anterior approach for uncemented total hip replacement in medial femoral neck fractures: a retrospective comparative study on the first 100 consecutive patients

BackgroundWith the aging of the population, the incidence of medial femoral neck fractures is likely to increase, and along them the need for total hip replacement. The present study aimed to analyze whether the use of the direct anterior hip approach, compared with posterolateral approach in medial proximal femur fracture patients, results in any advantage in terms of complications rate and functional recovery.MethodsA total of 162 patients were included in the study, and divided by approach: 100 performed with direct anterior approach (group A) and 62 with posterolateral approach (group B). The two populations were overlapping in age (75 vs 74 years; p = 0.13), sex (58F 42M vs 46F 16M; p = 0.12) and BMI (24 vs 24; p = 0.77).ResultsGroup A showed a higher ASA score compared to group B (3 vs 2; p = 0.04). Similar hospital stays (7 vs 7 days; p = 0.55) and complication rates (6% vs 8%; p = 0.61) were observed among groups, the most frequent being periprosthetic fractures, and need for allogeneic blood transfusion (20% vs 13%; p = 0.25). Patients in group A (96 vs 85 min; p = 0.10) showed a slightly, longer surgical time and a faster postoperative functional recovery witnessed by the ability to climb stairs at hospital discharge (37% vs 21%; p = 0.041).ConclusionThe use of the direct anterior hip approach was effective in the management of frail patients with medial femoral neck fractures managed by total hip arthroplasty, allowing faster functional recovery in the elderly population.

Intraoperative cell salvage in revision hip arthroplasty.

The aim of this study was to perform a systematic review of the evidence for the use of intraoperative cell salvage in patients undergoing revision hip arthroplasty, and specifically to analyze the available data in order to quantify any associated reduction in the use of allogenic blood transfusion, and the volume which is used. An electronic search of MEDLINE (PubMed), Embase, Scopus, and the Cochrane Library was completed from the date of their inception to 24 February 2022, using a search strategy and protocol created in conjunction with the PRISMA statement. Inclusion criteria were patients aged > 18 years who underwent revision hip arthroplasty when cell salvage was used. Studies in which pre-donated red blood cells were used were excluded. A meta-analysis was also performed using a random effects model with significance set at p = 0.05. Of the 283 studies which were identified, 11 were included in the systematic review, and nine in the meta-analysis. There was a significant difference (p < 0.001) in the proportion of patients requiring allogenic transfusion between groups, with an odds ratio of 0.331 (95% confidence interval (CI) 0.165 to 0.663) associated with the use of cell salvage. For a total of 561 patients undergoing revision hip arthroplasty who were treated with cell salvage, 247 (44.0%) required allogenic transfusion compared with 418 of 643 patients (65.0%) who were treated without cell salvage. For those treated with cell salvage, the mean volume of allogenic blood which was required was 1.95 units (390 ml) per patient (0.7 to 4.5 units), compared with 3.25 units (650 ml) per patient (1.2 to 7.0 units) in those treated without cell salvage. The mean difference of -1.91 units (95% CI -4.0 to 0.2) in the meta-analysis was also significant (p = 0.003). We found a a significant reduction in the need for allogenic blood transfusion when cell salvage was used in patients undergoing revision hip arthroplasty, supporting its routine use in these patients. Further research is required to determine whether this effect is associated with types of revision arthroplasty of differing complexity.

Appraisal of awareness of medical staff about preoperative patient blood management in Saudi Arabia: a questionnaire-based study

Patient blood management (PBM) is a comprehensive approach to optimizing the care of patients who might need a transfusion. It involves the use of evidence-based strategies to reduce or avoid the need for allogeneic blood transfusions while ensuring that patients receive safe and appropriate care. PBM includes strategies such as preoperative autologous donation, intraoperative cell salvage, and minimally invasive techniques to reduce bleeding. The purpose of this study is to assess the medical staff’s awareness of preoperative PBM in Saudi Arabia. Between April 2022 and July 2022, data was collected using a 10-minute online (Google Forms) self-administered, anonymous, researcherstructured questionnaire adapted from previous studies and translated into both English and Arabic. The questionnaire was divided into three sections. The first section contained sociodemographic data, while the second section was used to estimate physicians’ and nurses’ knowledge of preoperative PBM. Two questions in Part 3 of the questionnaire were used to assess doctors’ and nurses’ preoperative PBM attitudes and practices. The average relationship between patients’ blood management attitudes and levels of awareness. It was revealed that there was a positive attitude (P≤0.005) as well as a high level of awareness (P≤0.002). The effect of job, gender, or geographical distribution on PBM awareness, attitude, and practice was not significant. Despite the fact that the majority of participants have a positive attitude and good awareness of PBM, more efforts should be implemented to improve PBM awareness, which was linked to increased transfusion practices and lower product costs.

SP7.4 Autologous blood transfusion reduces the requirement for peri-operative allogenic blood transfusion in patients undergoing major hepatobiliary surgery

Abstract Aims Major HPB surgery is associated with a high risk of major blood loss. We aimed to assess whether autologous transfusion of blood salvaged intra-operatively reduces the requirement for post-operative allogenic transfusion. This is clinically important because blood is a scarce resource and allogenic transfusion is associated with the potential for morbidity. Methods We analysed data from a prospective database of 501 patients undergoing major HPB resection (2015–2022). Patients who received cell salvage (n=264) were compared with those who did not (n=237). Non-autologous transfusion was assessed from the time of surgery to 5 days post-surgery, and blood loss tolerance was calculated using the Lemmens-Bernstein-Brodosky formula. Multivariate analysis was used to identify factors associated with the need for allogenic blood transfusion. Results 32% of lost blood volume was replaced through autologous transfusion in patients receiving cell salvage. Although cell salvage patients experienced significantly higher intra-operative blood loss compared with the non-cell salvage group (1360ml vs 971ml, p=0.0005), they received significantly less allogenic red blood cell units (1.5 vs 0.92 units/patient, p=0.03). In addition, more of the non-cell salvage patients required low-level transfusion (≤3 units). Use of cell salvage and correction of blood loss tolerance are both independently associated with avoidance of transfusion. There was no difference in major morbidity, 30 or 90-day mortality between the groups. Conclusions Use of cell salvage was associated with a reduction in allogenic blood transfusion. Further work is needed to understand whether this is a cost-effective means of reducing allogenic transfusion to support the routine use of intraoperative cell salvage in major HPB surgery.

Reduction of EpCAM-Positive Cells from a Cell Salvage Product Is Achieved by Leucocyte Depletion Filters Alone.

Intraoperative cell salvage reduces the need for allogeneic blood transfusion in complex cancer surgery, but concerns about the possibility of it re-infusing cancer cells have hindered its application in oncology. We monitored the presence of cancer cells on patient-salvaged blood by means of flow cytometry; next, we simulated cell salvage, followed by leucodepletion and irradiation on blood contaminated with a known amount of EpCAM-expressing cancer cells, assessing also residual cancer cell proliferation as well as the quality of salvaged red blood cell concentrates (RBCs). We observed a significant reduction of EpCAM-positive cells in both cancer patients and contaminated blood, which was comparable to the negative control after leucodepletion. The washing, leucodepletion and leucodepletion plus irradiation steps of cell salvage were shown to preserve the quality of RBCs in terms of haemolysis, membrane integrity and osmotic resistance. Finally, cancer cells isolated from salvaged blood lose their ability to proliferate. Our results confirm that cell salvage does not concentrate proliferating cancer cells, and that leucodepletion allows for the reduction of residual nucleated cells, making irradiation unnecessary. Our study gathers pieces of evidence on the feasibility of this procedure in complex cancer surgery. Nevertheless, it highlights the necessity of finding a definitive consensus through prospective trials.

Interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews.

Interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews.

The role of intravenous tranexamic acid for blood loss in total hip arthroplasty secondary to femoral neck fracture

Aim: The aim of the study was to compare the efficacy of intravenous (IV) administration of tranexamic acid (TXA) in terms of bleeding volume, allogeneic blood transfusion (ABT) requirement, and complications in total hip arthroplasty (THA) secondary to osteoporotic femoral neck fracture (FNF).&#x0D; Material and Method: A total of 165 patients who underwent THA on the background of FNF in our clinic were included in the study. Patients' demographic data, preoperative and postoperative blood parameters, the amount of blood loss calculated according to the Nadler formula, amount of ABT, and complications at the 90-day follow-up were recorded. The patients were divided into two groups those who received 15mg/kg preoperatively and 10mg/kg IV TXA at the end of the operation (TXA group-89 patients) and those who did not receive TXA (Control group-76 patients) and the two groups were compared.&#x0D; Results: The total amount of bleeding calculated according to the Nadler formula was significantly less in the TXA group (1659,68±320,86ml) compared with the Control group (1774,43±365,24ml) (p=0.033). The need for ABT was 42.86% in the TXA group and 57.14% in the control group, and this difference was statistically significant (p=0.008).&#x0D; Conclusion: In patients who underwent THA on the basis of osteoporotic FNF, preoperative and postoperative administration of 2 doses of IV TXA significantly reduced total blood loss and the need for ABT. We suggest that IV TXA administration can be safely performed, especially in this patient group, to reduce the amount of bleeding and therefore the need for ABT by not increasing any thromboembolic complications.

Lower need for allogeneic blood transfusion after robotic low anterior resection compared with open low anterior resection: a propensity score-matched analysis

Robotic low anterior resection (R-LAR) for rectal cancer may decrease estimated blood loss compared with open low anterior resection (O-LAR). The aim of this study was to compare estimated blood loss and blood transfusion within 30 days after O-LAR and R-LAR. This was a retrospective matched cohort study based on prospectively registered data from Västmanland Hospital, Sweden. The first 52 patients operated on using R-LAR for rectal cancer at Västmanland Hospital were propensity score-matched 1:2 with patients who underwent O-LAR for age, sex, ASA (American Society of Anesthesiology physical classification system), and tumor distance from the anal verge. In total, 52 patients in the R-LAR group and 104 patients in the O-LAR group were included. Estimated blood loss was significantly higher in the O-LAR group compared with R-LAR: 582.7 ml (SD ± 489.2) vs. 86.1 ml (SD ± 67.7); p < 0.001. Within 30 days after surgery, 43.3% of patients who received O-LAR and 11.5% who received R-LAR were treated with blood transfusion (p < 0.001). As a secondary post hoc finding, multivariable analysis identified O-LAR and lower pre-operative hemoglobin level as risk factors for the need of blood transfusion within 30 days after surgery. Patients who underwent R-LAR had significantly lower estimated blood loss and a need for peri- and post-operative blood transfusion compared with O-LAR. Open surgery was shown to be associated with an increased need for blood transfusion within 30 days after low anterior resection for rectal cancer.

Spinal deformity surgery in patients for whom blood transfusion is not an option: a single-center experience.

Spinal deformity surgery is associated with significant blood loss, often requiring the transfusion of blood and/or blood products. For patients declining blood or blood products, even in the face of life-threatening blood loss, spinal deformity surgery has been associated with high rates of morbidity and mortality. For these reasons, patients for whom blood transfusion is not an option have historically been denied spinal deformity surgery. The authors retrospectively reviewed a prospectively collected data set. All patients declining blood transfusion who underwent spinal deformity surgery at a single institution between January 2002 and September 2021 were identified. Demographics collected included age, sex, diagnosis, details of any prior surgery, and medical comorbidities. Perioperative variables included levels decompressed and instrumented, estimated blood loss, blood conservation techniques used, length of surgery, length of hospital stay, and complications from surgery. Radiographic measurements included, where appropriate, sagittal vertical axis correction, Cobb angle correction, and regional angular correction. Spinal deformity surgery was performed in 31 patients (18 male, 13 female) over 37 admissions. The median age at surgery was 41.2 years (range 10.9-70.1 years), and 64.5% had significant medical comorbidities. A median of 9 levels (range 5-16 levels) were instrumented per surgery, and the median estimated blood loss was 800 mL (range 200-3000 mL). Posterior column osteotomies were performed in all surgeries, and pedicle subtraction osteotomies in 6 cases. Multiple blood conservation techniques were used in all patients. Preoperative erythropoietin was administered prior to 23 surgeries, intraoperative cell salvage was used in all, acute normovolemic hemodilution was performed in 20, and perioperative administration of antifibrinolytic agents was performed in 28 surgeries. No allogenic blood transfusions were administered. Surgery was staged intentionally in 5 cases, and there was 1 unintended staging due to intraoperative blood loss from a vascular injury. There was 1 readmission for a pulmonary embolus. There were 2 minor postoperative complications. The median length of stay was 6 days (range 3-28 days). Deformity correction and the goals of surgery were achieved in all patients. Two patients underwent revision surgery during the follow-up period: one for pseudarthrosis and the other for proximal junctional kyphosis. With proper preoperative planning and judicious use of blood conservation techniques, spinal deformity surgery may be performed safely in patients for whom blood transfusion is not an option. The same techniques can be applied widely to the general population in order to minimize blood loss and the need for allogeneic blood transfusion.

Preoperative Identification and Management of Anemia in the Colorectal Surgery Patient.

Preoperative anemia is a common finding in patients undergoing colorectal surgery, particularly those with cancer. While often multifactorial, iron deficiency anemia remains the most common cause of anemia in this patient population. Although seemingly innocuous, preoperative anemia is associated with an increased risk of perioperative complications and need for allogenic blood transfusions, both of which may worsen cancer-specific survival. Preoperative correction of anemia and iron deficiency is thus necessary to diminish these risks. Current literature supports preoperative screening for anemia and iron deficiency in patients slated to undergo colorectal surgery for malignancy or for benign conditions with associated patient- or procedure-related risk factors. Accepted treatment regimens include iron supplementation-either oral or intravenous-as well as erythropoietin therapy. Autologous blood transfusion should not be utilized as a treatment for preoperative anemia when there is time to implement other corrective strategies. Additional study is still needed to better standardize preoperative screening and optimize treatment regimens.