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Appropriate & Optimal Utilization of Blood4. Appropriate & Optimal Utilization of BloodAppropriate & Rational use of blood* Autologous blood transfusion * Reducing number of donor exposures * Blood component therapy * Blood sparing strategies Use of fresh blood less than 3 days should preferably be avoided as it may be untested or inadequately tested. In addition, there is an increased risk of transmission of viral infections from fresh blood, as the infectious agents may get inactivated on storage. Transfusion avoidance strategies should be followed, and patients should only be transfused when there is a definite indication to do so and its benefit outweighs the risk associated with it. Lowering the trigger value for transfusion to haemoglobin less than 7g/dl, if the fall in Hb has not been rapid, may also avoid unnecessary transfusions. Avoiding single unit transfusion, which insignificantly raise the Hb by 1 gldl, is another approach for rational use of blood. Auto-transfusion (Autologous Blood Transfusion) is a unique approach of providing the patients with their own blood and it helps in avoiding the use of homologous blood. Various categories of auto-transfusion have been defined * Preoperative (predeposit) * Periooperative haemodilution * lntraoperative salvage * Post-operative salvages All these measures help in reducing or eliminating the use of homologous blood and prevent the exposure of a patient to the risk of blood-borne endogenous infections. Reducing the exposure of patients to different donors will also decrease the risk of transfusion transmitted diseases. This is of importance in a paediatric patient requiring 30-50 ul of blood every day or on alternate days, who may be transfused with smaller quantity of blood separated from a single donor blood unit. ‘Walking donor programme’ is an approach of reducing the number of donor exposures. In this scheme, neonates requiring blood transfusion are given blood collected from donors who donate 50-60 ml of blood in heparinized syringes for direct transfusion to the newborns. These donors however must be tested for all mandatory markers of infection a day before the blood is being collected for transfusion. Blood component therapy is the most rational approach for appropriate utilization of blood for a particular patient. Treating any patient with specific components e.g. red cells, plasma or platelets will avoid unnecessary exposure to the component not required for that particular patient. Adequate blood inventory also helps to minimize transfusion of untested or improperly screened blood. Blood sparing strategies : * Pharmacological agents for bleeding patients e.g. DDAVP, trasylol (aprotinin) * Crystalloids/colloids * Haematinics for patients with anaemia * Generally engineered recombinant products - rF VIII, rF IX, rGF, rEpo * Blood substitutes - perfluorocarbons, modified haemoglobin solutions Patients receiving multiple transfusions, pooled plasma products, massive transfusion and unnecessary transfusions have increased risk of acquiring transfusion transmissible diseases. Therefore, whenever possible. “Blood Sparing Strategies” should be followed and safe alternatives to blood may be used. Pharmacologic agents may be used for bleeding patients e.g. DDAVP or desmopressin has been found to be useful in treatment of mild haemophilia. Similarly, vasconstrictor agent aprotinin (Trasylol) has been used to decrease the loss of blood from operative site during surgery. Crystalloids or colloid solutions (dextrose-saline, ringer lactate, dextran. etc.) may be used for mild to moderate blood loss and red cell transfusions may be limited only for patients with acute blood loss of > 1 litre. Haematinics may be used in patients with mild to moderate anaemia. Use of genetically engineered recombinant products will also decrease the risk of plasma-derived contaminated blood products. Research in the use of blood substitutes has a long way to go. However, blood (red cell) substitutes per fluorocarbons have now been licensed for use in Percutaneous Transluminal Coronary Angioplasty (PTCA) and modified hemoglobin solutions are also undergoing human trials. Constitution of a hospital transfusion committee to review blood usage, blood ordering strategies and active interaction amongst blood transfusion service and clinicians will definitely help in appropriate utiliation of blood, promotion of autologous blood transfusion and avoidance of unnecessary transfusions.
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