GENERAL SURGERY

Blood Transfusion and Alternative Therapies

• Blood transfusion is substantially overutilized and has significant associated risk, including: transfusion reactions, transmission of blood borne pathogens, and immune suppression.
• The accepted transfusion ‘‘trigger’’ in euvolemic patients is 7 gm/dl for healthy individuals and 8–9 gm/dl for patients with co-morbidities associated with decreased cardiopulmonary reserve.
• Blood transfusion is an independent predictor of MOF, SIRS, increased infection, and mortality in patients with severe injuries and undergoing complex surgical procedures.
• Transfusion of only the amount of blood that maximizes immediate survival and minimizes late inflammatory complications is the goal of resuscitation.
• Trauma patients and other patients in hemorrhagic shock should be transfused based upon blood pressure, pulse, and other measurements of decreased perfusion rather than relying upon laboratory values.