Basics of Blood
Management
Petra Seeber
MD
Department of Anesthesiology
Critical Care Medicine
Pain Management, Emergency Medicine
HELIOS Klinik Blankenhain
Wirthstr. 5
99444 Blankenhain
Germany
Aryeh Shander
MD, FCCM, FCCP, Chief
Department of Anesthesiology, Critical Care Medicine
Pain Management and Hyperbaric Medicine
Englewood Hospital and Medical Center
350 Engle Street
Englewood, NJ 07631
and
Clinical Professor of Anesthesiology, Medicine and Surgery
Mount Sinai School of Medicine, Mount Sinai Hospital,
New York
first edition
C
2007 Petra Seeber and Aryeh Shander
Published by Blackwell Publishing
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First published 2007
1 2007
Library of Congress Cataloging-in-Publication Data
Seeber, Petra.
Basics of blood management / Petra Seeber, Aryeh Shander. – 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN: 978-1-4051-5131-3
1. Transfusion-free surgery. 2. Blood–Transfusion. 3. Bland banks.
I. Shander, Aryeh. II. Title.
[DNLM: 1. Blood Substitutes–therapeutic use. 2. Blood Banks–organization &
administration. 3. Blood Loss, Surgical–prevention & control.
4. Blood Transfusion. WH 450 S451b 2008]
RD33.35.S44 2008
617–dc22
2007005030
ISBN: 978-1-4051-5131-3
A catalogue record for this title is available from the British Library
Set in 9.25/11.5 Minion by Aptara Inc., New Delhi, India
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responsibility or legal liability for any errors in the text or for the misuse or
misapplication of material in this book.
Contents
Preface to the first edition, vii
Acknowledgments, viii
Introduction, ix
1 History and organization of blood management, 1
2 Physiology of anemia and oxygen transport, 9
3 Anemia therapy I: erythropoiesis stimulating proteins, 21
4 Anemia therapy II (hematinics), 35
5 Growth factors, 50
6 Fluid therapy, 65
7 The chemistry of hemostasis, 77
8 Recombinant blood products, 96
9 Artificial blood components, 110
10 Oxygen therapy, 125
11 Preparation of the patient for surgery, 139
12 Iatrogenic blood loss, 160
13 The physics of hemostasis, 172
14 Anesthesia—more than sleeping, 191
15 The use of autologous blood, 200
16 Cell salvage, 211
17 Blood banking, 227
18 Transfusions. Part I: cellular components and plasma, 243
19 Transfusions. Part II: plasma fractions, 265
20 Law, ethics, religion, and blood management, 287
21 Step by step to an organized blood management program, 299
Appendix A: Detailed information, 322
Appendix B: Sources of information for blood management, 329
Appendix C: Program tools and forms, 334
Appendix D: Teaching aids: research and projects, 346
Appendix E: Address book, 350
Index, 376
Preface to first edition
The benefit-to-risk ratio of blood products needs constant
evaluation. Blood products, as therapeutic agents,
have had the test of time but lack the evidence we expect
from other medicinals. Blood, an organ, is used as
a pharmaceutical agent by the medical profession, due to
the achievements in collection, processing, banking, and
distribution. The fact that the most common risk of blood
transfusion is blood delivery error supports the notion that
blood is handled as a pharmaceutical agent. Over the last
few decades, the risk of blood transfusion and associated
complications has raised concerns about safety of blood
by both the public and health-care providers. At the same
time, experience with patients refusing blood and data on
blood conservation brought to light the real possibility of
other modalities to treat perisurgical anemia and to avoid
it with blood conservation methods. In addition to risks
and complications, data became available demonstrating
the behavioral aspect of transfusion practice versus an
evidence-based practice. In this book, the authors address
many aspects of modern transfusion medicine, known
blood conservation modalities, and new approaches to the
treatment of perisurgical anemia, as well as special clinical
considerations. This approach, now termed “blood management”
by the Society for the Advancement of Blood
Management, incorporates appropriate transfusion practice
and blood conservation to deliver the lowest risk and
highest benefit to the patient. In addition, it brings all
these modalities to the patient’s bedside and above all is a
patient-centered approach. Blood management is a multidisciplinary,
multimodality concept that focuses on the
patient by improving patient outcome, making it one of
the most intriguing and rewarding fields in medicine.
The benefit-to-risk ratio of blood products needs constant
evaluation. Blood products, as therapeutic agents,
have had the test of time but lack the evidence we expect
from other medicinals. Blood, an organ, is used as
a pharmaceutical agent by the medical profession, due to
the achievements in collection, processing, banking, and
distribution. The fact that the most common risk of blood
transfusion is blood delivery error supports the notion that
blood is handled as a pharmaceutical agent. Over the last
few decades, the risk of blood transfusion and associated
complications has raised concerns about safety of blood
by both the public and health-care providers. At the same
time, experience with patients refusing blood and data on
blood conservation brought to light the real possibility of
other modalities to treat perisurgical anemia and to avoid
it with blood conservation methods. In addition to risks
and complications, data became available demonstrating
the behavioral aspect of transfusion practice versus an
evidence-based practice. In this book, the authors address
many aspects of modern transfusion medicine, known
blood conservation modalities, and new approaches to the
treatment of perisurgical anemia, as well as special clinical
considerations. This approach, now termed “blood management”
by the Society for the Advancement of Blood
Management, incorporates appropriate transfusion practice
and blood conservation to deliver the lowest risk and
highest benefit to the patient. In addition, it brings all
these modalities to the patient’s bedside and above all is a
patient-centered approach. Blood management is a multidisciplinary,
multimodality concept that focuses on the
patient by improving patient outcome, making it one of
the most intriguing and rewarding fields in medicine.
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