Cardiac Surgery Without Transfusion: A Reappraisal
In the 1970’s, it was not uncommon for patients undergoing open heart surgery to be typed and crossed for 20 or more units of blood. Much of this was used to prime the heart/lung machine; some was transfused directly to the patient. At that time, blood transfusion was regarded as an innocuous procedure with little risk other than an occasional transfusion reaction and the rare case of hepatitis. We have learned much about the dangers of transfusion in cardiac surgery since that time, spurred on by the appearance of AIDS in a number of former patients. The risk of transmitting not only AIDS but also other viruses such as cytomegalovirus and hepatitis has been joined by the potential of immunosuppressing our patients and increasing their susceptibility to infection through transfusion. The need to avoid these complications and to provide a greater margin of safety are compelling reasons to review and revise our transfusion practices. The paragraphs that follow address the progress we have made toward the goal of bloodless cardiac surgery and offer both recommendations for current practice and suggestions for the future.
KeywordsFibrin Glue Fresh Freeze Plasma Open Heart Surgery Hydroxyethyl Starch Homologous Blood
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