Alternatives to Blood Transfusions
Fall 2004
Acute normovolemic hemodilution (ANH) and preoperative
autologous blood
donation (PABD) are two techniques used for patients
who refuse donor blood
transfusions, due to safety concerns or personal
reasons.
Acute normovolemic hemodilution, or ANH, is a
technique used in bloodless
surgery, which significantly reduces the amount
of red blood cells lost during
surgery. Prior to surgery, an IV is started in
the patient's arm and blood is slowly
drained inside a closed system. A combination
of water and minerals replaces the
blood, which helps to maintain the patient's
vital sign stability.
During the surgery,
some blood is lost; however, since the blood
has been diluted, it contains fewer
cells and more liquid. The anesthesiologist is
then able to give back whole, fresh
blood to the patient. The blood never loses contact
with the patient's own
circulatory system, so there is no chance of
clerical error, which can occur with
preoperative autologous blood donation.
Another
alternative to donor blood transfusions, preoperative
autologous blood donation (PABD), involves the
collection and reinfusion of the patient's own
blood. Two to three weeks prior
to surgery, patients donate two to four units
of their own blood, which is then given back
to them during or after surgery.
People who
refuse blood transfusions for religious or
personal reasons should note that
preoperative autologous blood donation involves
storing the blood. In some cases,
storage of one's own blood for anticipated
reinfusion has lead to clerical errors
and resulted in the transfusion of someone
else's blood. Also, PABD cannot be
performed in patients undergoing non-elective
surgical procedures.
Why is ANH effective?
The ANH method reduces and eliminates the need
for a blood transfusion by
decreasing the amount of red blood cells lost
during surgery. Since a blood
transfusion is usually not required, there is
no risk of an allergic reaction or disease
transmission. With PABD, patients who donate
their own blood weeks before
surgery are doing so with lower blood counts.
These
patients would be more likely to need a transfusion
sooner than someone who did not donate their
own blood. In conclusion, ANH is less costly
and equally as effective as PABD, in addition
to being a more convenient method for the
patient.
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