Alternatives used to avoid allogenic blood transfusions and their disadvantages | |
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Preoperative Blood Donation (PAD) | • Cardiac, Vasovagal (Risk Factors: Younger Age, Lower weight, 1Sttime donation) [34] • 12 times increase in Anginal and Vasovagal complications (Risk Factor: 1sttime donation) [35] • Overall increase frequency of transfusion (Risk Factor: Lower Preoperative Hematocrit) [36, 37] • Not Cost Effective in Orthopaedic Procedures [38](More expensive to produce one unit of autologous blood, Cost also incurred in disposal of more than half of the blood discarded which is not used) |
Acute Normovolemic Hemodilution (ANH) | Not effective in Orthopedic Procedures (data termed inconclusive) [39] |
Perioperative red cell salvage (PCS) | Cost effectiveness of the postoperative blood collection devices was challenged (1stsix hour collection would cost 31-35 million dollars) [40] |
Deliberate Hypotension DH) | Persistent hypotension, Reactionary haemorrhage, Cardiac Ischemic Injury, Ischemic Optic neuritis [41–43] |
Recombinant Human Erythropoietin (RHE) | Routine use not justified due to high cost [44] |
Tranexamic acid | |
Aprotinin | • Low dose not effective in orthopedic procedure [45] • Evidence has been published to suggest an increase in renal events in patients given aprotinin when compared to those where tranexamic acid was used [46] |