Correspondence* – Introduction:
To the Editor:
Blood transfusion is among the most common procedures performed in hospitalized patients; however, advances in our knowledge of the risks associated with transfusions and a growing population of patients who wish to avoid transfusions have led to new treatment paradigms for anemia.1–4 The majority of patients requesting management without transfusions (frequently denoted “bloodless”) are members of the Jehovah’s Witness (JW) faith, comprising over 8 million individuals worldwide with 1.2 million in the United States.5 JW doc- trines forbid transfusion of “primary” blood components (red cells, platelets, leukocytes, plasma) while individual clotting factor concentrates and albumin may be accepted at the individual’s discretion.4–6 Most will accept autologous blood collected from the surgical field using an instrument (cell saver) that is physically contiguous with the body, although autologous blood donated preoperatively is generally not accepted.4,5 These patients present unique challenges, particularly in the setting of anemia and surgical procedures associated with significant blood loss. Prior studies focused on cardiac surgery suggest that bloodless patients have comparable outcomes to those receiving standard care.6–12 However, there are limited retrospective data and no established guidelines to inform management. Here, we report a six-year experience with preoperative management of anemia in bloodless patients based on treatment protocols developed at our institution. Since transfusions can be risk factors for adverse outcomes independent of anemia,5,6,11,13–17 lessons learned from this population are likely to benefit all patients.
*This correspondence contains a protocol for preoperative evaluation and management of anemia in bloodless patients with specific dosing recommendations.
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