Limiting excessive postoperative blood transfusion after cardiac procedures: A review

V. A. Ferraris, S. P. Ferraris

Research output: Contribution to journalReview articlepeer-review

66 Scopus citations


Analysis of blood product use after cardiac operations reveals that a few patients (≤20%) consume the majority of blood products (>80%). The risk factors that predispose a minority of patients to excessive blood use include patient-related factors, transfusion practices, drug-related causes, and procedure related factors. Multivariate studies suggest that patient age and red blood cell volume are independent patient-related variables that predict excessive blood product transfusion after cardiac procedures. Other factors include preoperative aspirin ingestion, type of operation, over- or underutilization of heparin during cardiopulmonary bypass, failure to correct hypothermia after cardiopulmonary bypass, and physician overtransfusion. A survey of the currently available blood conservation techniques reveals 5 that stand out as reliable methods: 1) high-dose aprotinin therapy, 2) preoperative erythropoietin therapy when time permits adequate dosage before operation, 3) hemodilution by harvest of whole blood immediately before cardiopulmonary bypass, 4) autologous predonation of blood, and 5) salvage of oxygenator blood after cardiopulmonary bypass. Other methods, such as the use of ε-aminocaproic acid or desmopressin, cell saving devices, reinfusion of shed mediastinal blood, and hemofiltration have been reported to be less reliable and may even be harmful in some high-risk patients. Consideration of the available data allows formulation of a 4-pronged plan for limiting excessive blood transfusion after surgery: 1) recognize the causes of excessive transfusion, including the importance of red blood cell volume, type of procedure being performed, preoperative aspirin ingestion, etc.; 2) establish a quality management program, including a survey of transfusion practices that emphasizes physician education and availability of real-time laboratory testing to guide transfusion therapy; 3) adopt a multimodal approach using institution-proven techniques; and 4) continually reassess blood product use and analyze the cost-benefits of blood conservation interventions.

Original languageEnglish
Pages (from-to)216-230
Number of pages15
JournalTexas Heart Institute Journal
Issue number3
StatePublished - 1995


  • Aprotinin
  • aspirin
  • blood coagulation tests
  • blood loss, surgical/drug therapy
  • blood preservation
  • blood transfusion
  • blood transfusion, autologous
  • cardiopulmonary bypass, erythropoietin
  • hemodilution
  • hemofiltration, heparin coating
  • hypothermia, induced

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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