[Rational hemotherapy. Indications, complications and practical performance].

Abstract

Employment of allogenic blood products involves the risk of a series of complications in the recipient: transfusion-transmitted disease, immune suppression, immunological transfusion reactions and coagulopathy. Hepatitis C is the most common transfusion-transmitted infection with a post-transfusion incidence of 2-4%. Transfusion-transmitted AIDS plays a quantitatively lesser role but the course of the condition is frequently fatal. The duration of the period during which a HIV-sero-negative individual is potentially infectious is uncertain. After blood transfusion, the immune apparatus is suppressed, probably on account of the leukocyte content of the blood transfusion. These disturbances in immune function increase the risk of infection and possibly the frequency of recurrence of cancer after operative treatment of a series of neoplastic diseases. Coagulopathy after blood transfusion may be related primarily to the number of transfusions and can be counteracted by administration of the relevant coagulation factors. Rational hemotherapy aims at minimizing these transfusion-related complications by restricting the indications for blood transfusion, blood component therapy, peroperative normovolaemic haemodilution, preoperative deposition of autologous blood and/or peroperative collection of blood and re-infusion. Employing rational hemotherapy, it becomes possible to reduce the need for transfusion by 20-90% and hence the morbidity and the mortality connected with blood transfusion.