Basics of Blood Management

Aryeh Shander, MD, is Clinical Professor of Anesthesiology, Medicine and Surgery at the Mount Sinai School of Medicine in New York City, Chief, Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ Dr Shander lectures nationally and internationally on a variety of topics relating to blood conservation, volume resuscitation, acute anemia therapy, surgical blood management, acute normovolemic hemodilution and bloodless medicine and surgery. His publications have appeared in The Lancet, the journal Transfusion, and Transfusion Alternatives in Transfusion Medicine, for which he serves in Editorial and Scientific Boards. He serves as Chief Executive Officer of the Society for the Advancement of Blood Management and is Fellow of the American College of Critical Care Medicine and the American College of Chest Physicians. Dr Schander is a member of the American Society of Critical Care Anesthesiologists where he serves on committees, both locally and nationally, and in addition, is a member of the American Association of Blood Banks (AABB), American Society of Anesthesiologists (ASA) and a founding member of the American Society of Critical Care Anesthesiologists (ASCCA). In 1997 Dr Shander was recommended by Time magazine as one of America's "Heroes of Medicine". Dr Shander received his medical degree from the University of Vermont College of Medicine and completed an internship and residency in internal medicine at Montefiore Medical Centre in New York, where he also served as Chief Resident. Additional postgraduate training included a fellowship in critical care medicine and a residency in anesthesiology, both at Montefiore Medical Centre. Dr Seeber, Department of Anesthesiology, Critical Care, Pain Management and Emergency Medicine, HELIOS Klinik, Blankenhain, Germany.

System. 1. History and Organization of Blood Management * Blood management as a program * The administrative part * The physician's part. 2. Physiology of Anemia and Oxygen Transport * Regular physiology * Physiology of anemia * Relationship between oxygen delivery and oxygen consumption * Practical implications. 3. Anemia Therapy, Part 1 (EPO, NESP and Anabolics) * Erythropoietin in normal erythropoiesis * Erythropoietin as a drug * Novel erythropoiesis stimulating protein (NESP, Darbepoetin) * Anabolic steroids. 4. Fluids * Need for fluid therapy * Basics of volume household and iv fluids * Crystalloid solutions * Colloid solutions * Side effects * Fluids at work * Influence of fluid therapy on blood management. 5. Use of Autologous Blood * Preoperative autologous donation * Hemodilution * Comparison of PAD and ANH * Platelet and Plasmapheresis. 6. Preparation of the Patient for Surgery * History and physical examination * Laboratory and other tests * Plan of care * Preparation. 7. Law, Ethics, Religion and Blood Management * Principles as basis for decision-making in blood management * Principles of bioethics * Human rights and patient's rights * Excursus * Jehovah's Witnesses * Compassionate use. 8. Recombinant Blood Products * Basics of recombinant drugs * Use of recombinant blood proteins in blood management * Comparison of recombinant and plasma-derived blood proteins. 9. Anemia Therapy, Part 2 (Hematinics * Physiology of erythropoiesis and hemoglobin synthesis * Iron therapy in blood management * Copper * Vitamin therapy in blood management * Interactions of hematinics * Implications for blood management. 10. Iatrogenic Blood Loss * Causes of iatrogenic blood loss * The role of iatrogenic blood loss in blood management * Avoidance of iatrogenic blood loss. 11. Antifibrinolytics, Vitamin K and Estrogens * Antifibrinolytics * Desmopressin * Vitamins of the K-Group * Conjugated estrogens and other hormones * Other hemostatic drugs. 12. Surgery: They Physics of Hemostasis * Basics of surgical techniques * Surgical tools * Methods to achieve hemostasis and to avoid undue blood loss * Positioning * Methods for surgical cutting . 13. Cell Salvage * Cell savers * Advantages of cell salvage * Practical considerations for cell salvage * Risks and side effects of cell salvage * Concerns: how to overcome contraindications * Indications for cell salvage * Cell salvage and concomitant diseases. 14. Tranfusions, Part A (Cellular Components, Plasma) * Why do physicians transfuse? * Ordering blood products * Risks and side effects of transfusions * Outcome measures * Guidelines * Leukoreduction * Massive transfusion * Practical management of transfusion * Levels of evidence/grades of recommendations. 15. Oxygen Therapy * Physics and physiology of oxygen * Oxygen, friend and enemy * Efects of pressurized oxygen on the human body * Normobaric inhalational oxygen therapy * Hyperbaric oxygen * Oxygen in blood management. 16. Artificial Blood Components * Artificial oxygen carriers * Hemoglobin-based oxygen carriers (HBOC) * Perfluorocarbons (PFC) * Artificial oxygen carriers in blood mangement * Other attempts to make artificial blood components. 17. Transfusions, Part B (Plasma Fractions) * The anatomy of plasma * Plasma fractions * Plasma fractions in blood management * Approaches to reduce the use of plasmatic fractions. 18. Blood Banking * Blood safety * What is test for in blood products and how * Storage and delivery * Whole blood to cellular components * Leukocyte depletion * Bacterial contamination * Plasma fractionation * Pathogen reduction * The interaction of blood banks and clinicians. 19. Cost Considerations * Basics of medical economy * Methods to calculate costs of a medical product or service * Costs of transfusion * Costs of methods to reduce transfusion requirements * Costs of a blood management program. 20. Step by Step to an Organized Blood Management System. 21. Law, ethics, religion, and blood management. 22.Step by step to an organized blood management program. Appendix A: Detailed information. Appendix B: Sources of information for blood management. Appendix C: Program tools and forms. Appendix D: Teaching aids: research and projects. Appendix E: Address book. Index