PubMed · 14419082
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W LUTZEYER. 1960. [The citrate stabilizers].. https://pubmed.ncbi.nlm.nih.gov/14419082/
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During the past 20 years, the perceived value of blood transfusions has changed as it has become appreciated that transfusions are not without risk. Red blood cell transfusion has been associated with disease transmission and immunosuppression for some time. More recently, proinflammatory consequences of red blood cell transfusion have also been documented. Moreover, it has become increasingly evident that stored red blood cells undergo time-dependent metabolic, biochemical, and molecular changes. This 'storage lesion' may be responsible for many of the adverse effects of red blood cell transfusion. Clinically, the age of blood has been associated with multiple organ failure, postoperative pneumonia, and wound infection. The relationship between age of blood and clinical adverse effects needs further study.
Intraoperative autologous transfusions have been used for many years to avoid transmission of infections, especially in vascular surgery, where blood usage is considerable. Several autotransfusion devices exist, but these devices are often associated with negative outcomes such as cost, contamination, and removal of essential blood components (e.g. platelets). Preoperative autologous blood donation is another blood preservation method to avoid possible transfusion-related infections. Several vascular surgery groups have compared the use of these techniques, and their results are discussed in this review. Cell saver techniques often do not prevent the need for transfusions, nor are they very cost-effective; therefore, their use should be considered on a case-by-case basis.
The quality and economy of critical care could both be improved if blood losses due to phlebotomy and sampling from indwelling catheters for unnecessary diagnostic testing were curtailed. Practice guidelines can help to break bad diagnostic 'habits', such as fever work-ups that require substantial blood to be drawn yet typically yield little useful information. Invasive hemodynamic monitoring is associated with morbidity due to blood loss as well as infection, and newer noninvasive technologies should be encouraged. Several devices allow blood that would otherwise be wasted during sampling to be returned to the patient aseptically. Point-of-care testing uses microliter quantities of blood, has acceptable precision, and can provide valuable diagnostic information while being minimally invasive.