Bloodless medicine: clinical care without allogeneic blood transfusion

Bloodless medicine refers to emerging clinical strategies for medical care without allogeneic blood transfusion and is a well-defined area in blood management. The circular of information distributed with blood and blood components recommends that all physicians be familiar with the alternatives that are a part of bloodless medicine. The circular states on p. 11 that “red cell-containing components should not be used to treat anemias that can be corrected with specific medications .... ” 1 The purpose of this article is to present an overview of these alternatives and to discuss how their appropriate use can achieve a goal of bloodless medicine. Bloodless medicine has traditionally been considered in a number of clinical settings: when patients object to transfusion for religious reasons (e.g., Jehovah’s Witnesses), when blood may be in short supply or not available, or when safe (i.e., screened and tested) blood is not available. Trauma, military field casualties, and massive transfusion settings are examples of the need for bloodless medicine when blood may be in short supply or not available. Additionally, an estimated 13 million units of donated blood worldwide are not tested for the HIV or hepatitis viruses, settings in which safe blood is not available. 2 Finally, compatible blood transfusion may be unobtainable for patients with multiple antibodies or may be undesirable for patients with autoimmune hemolytic anemia, particularly in the setting of autoerythrocyte sensitization. 3