PT  - JOURNAL ARTICLE
AU  - Ajay Kumar
TI  - Perioperative management of anemia: Limits of blood transfusion and alternatives to it
AID  - 10.3949/ccjm.76.s4.18
DP  - 2009 Nov 01
TA  - Cleveland Clinic Journal of Medicine
PG  - S112--S118
VI  - 76
IP  - 10 suppl 4
4099  - http://www.ccjm.org/content/76/10_suppl_4/S112.short
4100  - http://www.ccjm.org/content/76/10_suppl_4/S112.full
SO  - Cleve Clin J Med2009 Nov 01; 76
AB  - Perioperative anemia is associated with excess morbidity and mortality. Transfusion of allogeneic blood has been a longstanding strategy for managing perioperative anemia, but the blood supply is insufficient to meet transfusion needs, and complications such as infection, renal injury, and acute lung injury are fairly common. Further, data suggest that mortality and length of stay are worsened with liberal use of transfusion. Medical alternatives to transfusion include iron supplementation and erythropoiesis-stimulating agents (ESAs). Though ESAs reduce the need for perioperative blood transfusion compared with placebo, they are associated with an increased risk of thrombotic events in surgical patients. Cleveland Clinic has been developing a blood management program aimed at reducing allogeneic blood exposure for greater patient safety; the program has achieved some reduction in blood utilization in its first 7 months.