Blood Transfusion Practices in Cardiovascular Surgery

  • Richard K. Spence
  • Aurel C. Cernaianu
  • Anthony J. DelRossi


Blood transfusion has made cardiovascular surgery possible. Without the ability to prime the heart lung machine or to replace losses encountered during aortic procedures, cardiovascular surgery would not exist as we know it today. As cardiovascular procedures became more prevalent, the amount of blood transfused increased. It was not uncommon in the recent past to type and cross patients for 20 or more units of blood for a major cardiovascular procedure. The widespread use of large amounts of blood was justified by the belief that transfusion was innocuous, carrying little risk beyond the rare reaction and the occasional case of hepatitis. This sense of security disappeared abruptly in the 1980’s when transfusion-related acquired immune deficiency syndrome (AIDS) surfaced. Although the incidence of post-transfusion AIDS was, and still is, very low, the fact that the disease is uniformly fatal was enough to cause cardiovascular surgeons to reassess their transfusion practices and to look for alternatives to homologous blood.


Cardiovascular Surgery Homologous Blood Shed Blood Autologous Blood Donation Major Vascular Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lowery TA Clark JA: Successful Implementation of a Maximum Surgical Blood Ordering Schedule. J Med Assoc Ga 1989; 78(3): 155–158.PubMedGoogle Scholar
  2. 2.
    Axelrod FB Pepkowitz SH Goldfinger D: Establishment of a schedule of optimal preop-erative collection of blood. Transfusion 1989; 29: 677–680.PubMedCrossRefGoogle Scholar
  3. 3.
    Cosgrove DM Loop FD Lytle BN et al: Determinants of Blood Utilization during Myocardial Revascularization. Ann Thorac Surg 1985; 40: 380–384.PubMedCrossRefGoogle Scholar
  4. 4.
    Spence RK Carson JA Poses R et al: Elective surgery without transfusion: influence of preoperative hemoglobin level and blood loss on mortality. Am J Surg 1990; 159: 320–324.PubMedCrossRefGoogle Scholar
  5. 5.
    Owings DV Kruskall MS Thurer RL et al: Autologous blood donations prior to elective cardiac surgery. JAMA 1989; 262(14): 1963–1968.PubMedCrossRefGoogle Scholar
  6. 6.
    Britton LW Eastlund DT Dziuban SW et al: Predonate autologous blood use in elective cardiac surgery. Ann Thorac Surg 1989; 47: 529–532.PubMedCrossRefGoogle Scholar
  7. 7.
    Toy PTCY Strauss RG Stehling LG et al: Predoeposited autologous blood for elective surgery: a national multicenter study. N Engl J Med 1987; 316(9): 517–520.PubMedCrossRefGoogle Scholar
  8. 8.
    Goodnough LT Johnston MFM Toy PTCY et al: The variability of transfusion practice in coronary artery bypass surgery. JAMA 1991; 265(1): 86–90.PubMedCrossRefGoogle Scholar
  9. 9.
    The National Blood Resource Education Program Expert Panel. The use of autologous blood. JAMA 1990; 263: 414–447.CrossRefGoogle Scholar
  10. 10.
    Goodnough LT: Erythropoietin as a pharmacologic alternative to blood transfusion in the surgical patient. Transf Med Rev 1990; IV(4): 296–299.Google Scholar
  11. 11.
    Spiess BD Sassetti R McCarthy RJ et al: Autologous blood donation: hemodynamics in a high-risk patient population. Transfusion 1992; 32: 17–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Sandier SG Sacher RA: Preoperative autologous blood donation by high-risk patients. Transfusion 1992; 32: 1–2.CrossRefGoogle Scholar
  13. 13.
    Hallet JW Jr: Minimizing the use of homologous blood products during repair of abdominal aortic aneurysms. Surg Clinics N Amer 1989; 69(4): 817–826.Google Scholar
  14. 14.
    Brewster DC Ambrosion JJ Darling RC et al: Intraoperative autotransfusion in major vascular surgery. Am J Surg 1979; 137: 507–513.PubMedCrossRefGoogle Scholar
  15. 15.
    Boldt J Kling D von Bormann B et al: Blood conservation in cardiac operations: Cell separation versus hemofiltration. J Thorac Cardiovasc Surg 1989; 97: 832–840.PubMedGoogle Scholar
  16. 16.
    Dietrich W Barankay A Dilthey G et al: Autotranfusion and hemoseparation in cardiac surgery. What can be saved in cardiac reoperations and operations of thoracic aortic aneurysms? Thorac Cardiovasc Surg 1989; 37: 84–88.PubMedCrossRefGoogle Scholar
  17. 17.
    Pittman RD Inahra T: Eliminating homologous blood trasnfusions during abdominal aortic aneurysm repair. Am J Surg 1990; 159: 522–524.PubMedCrossRefGoogle Scholar
  18. 18.
    Cooley DA Crawford ES Howell JF et al: Open heart surgery in Jehovah’s Witnesses. Am J Cardiol 1964; 13: 779–781.PubMedCrossRefGoogle Scholar
  19. 19.
    Beall AC Yow EM Bloodwell MJ et al: Open heart surgery without blood transfusion. Arch Surg 1967; 94: 567–570.PubMedCrossRefGoogle Scholar
  20. 20.
    Hallowell P Bland JHL Buckley MJ et al: Transfusion of fresh autologous blood in open-heart surgery. A method for reducing bank blood requirements. J Thorac Cardiovasc Surg 1972; 64: 941–948.PubMedGoogle Scholar
  21. 21.
    Stehling L Zauder HL: Acute normovolemic hemodilution. Transfusion 1991; 31(9): 857–869.PubMedCrossRefGoogle Scholar
  22. 22.
    Ness PM Bourke DL Walsh PC: A randomized trial of perioperative hemodilution versus transfusion of preoperatively deposited autologous blood in elective surgery. Transfusion 1991; 31(9): 226–240.Google Scholar
  23. 23.
    DelRossi AJ Cernaianu AC Vertrees RA et al: Platelet-rich plasma reduces postoperative blood loss after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1990; 100(2):281–286.Google Scholar
  24. 24.
    Giordano GF Sr Girodano GF Jr Rivers SL et al: Determinants of homologous blood usage utilizing autologous platelet-rich plasma in cardiac operations. Ann Thorac Surg 1989; 47: 897–902.PubMedCrossRefGoogle Scholar
  25. 25.
    Pearlman NW Stiegmann GV Vance V et al: A prospective study of incisional time blood loss pain and healing with carbon dioxide laser scalpel and electrosurgery. Arch Surg 1991; 126: 1018–1020.PubMedCrossRefGoogle Scholar
  26. 26.
    Spence RK: The status of bloodless surgery. Trans Med Rev 1991; V(4),274–286.CrossRefGoogle Scholar
  27. 27.
    Cambria RP Brewster DC Abbot WM et al: Transperitoneal versus retroperitoneal approach to aortic reconstruction: A prospective study. J Vasc Surg 1990; 11: 314–325.PubMedGoogle Scholar
  28. 28.
    Fisher JB Dennis RC Valeri CR et al: Effect of graft material on loss of erythrocytes after aortic operations. SGO 1991; 173: 131–136.PubMedGoogle Scholar
  29. 29.
    Reid DB Pollock JG: A prospective study of 100 gelatin-sealed aortic grafts. Ann Vasc Surg 1991; 5: 320–324.PubMedCrossRefGoogle Scholar
  30. 30.
    Salzman EW Weinstein MJ Wientraub RM et al: Treatment with desmopressin acetate to reduce blood loss after cardiac surgery: a double blind randomized trial. N Engl J Med 1986; 314: 1402–1406.PubMedCrossRefGoogle Scholar
  31. 31.
    Rocha E Llorens R Paramo JA et al: Does desmopressin acetate reduce blood loss after surgery in patients on cardiopulmonary bypass? Circulation 1988; 77: 1319–1323.PubMedCrossRefGoogle Scholar
  32. 32.
    Hackman T Gascoyne RD Naiman SC et al: A trial of desmopressin (1-desamino-8-D-Arginine Vasopressin) to reduce blood loss in uncomplicated cardiac surgery. N Engl J Med 1989; 321: 1437–1443.CrossRefGoogle Scholar
  33. 33.
    D’Ambra MN Risk SC: Aprotinin erythropoietin and blood substitutes. Int Anesthes Clin 1990; 28(4): 237–240.Google Scholar
  34. 34.
    Wildevuur RH Eijsman L Gu YJ et al: Aprotinin reduces bleeding during cardiopulmonary bypass in aspirin treated patients. J Cadiovasc Surg 1990; 31: 34.Google Scholar
  35. 35.
    Royston D Bidstrup BP Taylor KM et al: Effect of Aprotinin on need for transfusion after repeat Open Heart Surgery. Lancet 1987; 2: 1289–1291.PubMedCrossRefGoogle Scholar
  36. 36.
    Czer LSC Bateman Gray RJ et al: Treatment of svere platelet dysfunction and hemorrhage after cardiopulmonary bypass: Reduction in blood product usage with Desmopressin. J Am Coll Cardiol 1987; 9: 1139–1147.PubMedCrossRefGoogle Scholar
  37. 37.
    Spence RK McCoy S Costabile J et al: Fluosol DA-20 in the treatment of severe anemia: randomized controlled study of 46 patients. Crit Care Med 1990; 18(11): 1227–1230.PubMedCrossRefGoogle Scholar
  38. 38.
    Adan A Brutel de 1a Riviere A Haas F et al: Autotransfusion of Drained Mediastinal Blood after Cardiac Surgery: a reappraisal. Thorac Cardiovasc Surg 1988; 36: 10–14.PubMedCrossRefGoogle Scholar
  39. 39.
    Roberts SR Early GL Brown B et al: Autotransfusion of unwashed shed mediastinal blood fails to decrease banked blood requirements in patients undergoing aortocoronary bypass surgery. Am J Surg 1991; 162: 477–480.PubMedCrossRefGoogle Scholar
  40. 40.
    Smoller BR Kruskall MS: Phlebotomy for diagnostic laboratory tests in adults: pattern of use and effect on transfusion requirements. N Eng J Med 1986; 314: 1233–1235.CrossRefGoogle Scholar
  41. 41.
    Welch HG Meehan KR Goodnough LT: Prudent strategies for elective red blood cell transfusion. Ann of Int Med 1992; 116(5): 393–402.Google Scholar

Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • Richard K. Spence
    • 1
  • Aurel C. Cernaianu
    • 1
  • Anthony J. DelRossi
    • 1
  1. 1.Robert Wood Johnson Medical SchoolUniversity of Medicine and Dentistry of New JerseyCamdenUSA

Personalised recommendations