Alternatives in the prophylaxis and therapy of perioperative anemia

Perisurgical anemia greatly decreases the postoperative quality of life and general recovery,impairs postoperative wound healing and can delay postoperative adjuvant chemotherapy for cancer. Indications for perioperative homologous transfusions have changed markedly over the last 10 years. Although the risk of transmission of viral infectious diseases by blood transfusion has declined dramatically during recent years, there are still risks of allergic reactions, transfusion reactions and immunosuppression followed by an increased rate of wound infection, morbidity or cancer recurrence. A well established option for avoiding allogeneic blood transfusion and preventing perioperative anemia is autologous blood donation. Other techniques are being developed,such as acute normovolemic hemodilution or, recently the perioperative treatment with recombinant human erythropoietin. Quality of life, practicability and efficacy seem to make drug therapy with erythropoietin an attractive option. Alternative strategies for avoiding allogeneic blood transfusion should be evaluated and used With increasing intensity in the perioperative management of gynecological and obstetrical surgery.