The Limits of Bloodless Surgery

SUMMARY Bloodless surgery refers to performing surgery without the use of blood. Such programs were developed to support Jehovah's Witness patients but the principles of care that have been established should be used in the care of all patients. However, there are limits to the ability of patients to tolerate anemia. Animal experiments show that myocardial ischemia develops around 5 g/dL and death at 3 g/dL. Studies in humans undergoing surgery demonstrate a linear relationship between death and anemia and poor outcome is extremely common below 5–6 g/dL. Patients with cardiovascular disease appear less tolerant of anemia. The care of the bloodless surgery patient involves careful preoperative planning, correction of anemia, use of erythropoietin, prompt surgery to stop bleeding, and meticulous surgical technique.