I am happy to be with the news Letter again after a short break. Among the various problems that we face in our daily practice, the need for “Blood Conservation” has acquired importance in recent times due to scarcity of this precious commodity and incidents of transfusion meditated hazards. Anaesthetic practice is one practice of medicine where the number of blood transfusion handled by a single doctor is highest. Concerns about the physiological effects of anaemiahave been proved baseless. There is no evidence that mild to moderate anaemia delays hospital stay, increases bleeding and delays wound healing. There is no difference in morbidity and mortality till the Hb level fell below 7gdl. Blood volume and perfusion are more important than mere Hb levels. The goal now is to anticipate, on a patients basis, the minimum Hb level that will avoid organ damage due to oxygen deprivation. This requires understanding not only of Hb and oxygen consumption and delivery at tissue level. Knowledge of assessment of patient’s physiological capacity for compensation of mechanism that enhances oxygen delivery under the conditions of anaemia is of paramount importance. Once there is a determination from the anaesthesiology community that blood transfusion has to be given only on a patient specific basis, various other methodologies of blood conservation can be practiced by them. Every effort should be taken to try and make their blood conservation techniques simple, safe, cost effective and easy to practice in our settings. Methods that can be tried to economise the use of blood include positioning during surgery, use of regional anaesthesia, manipulation of blood pressure, pharmacological agents to reduce blood loss (Approtinin, Tranexmic acid and EACA), understanding oxygen therapeutics, use of autologus transfusion and use of stoma free haemoglobin and perfluro carbons. Patients who require blood and blood products must be transfused that particular components only. It will be desirable if the decision to use the blood components is made in consultation with tranfusion specialist. Review of blood usage periodically, constituting hospital transfusion committee and conducting monthly medical audit on blood transfusion aresome of the steps towards a successful blood conservation. Appropriate use of blood and its components is required to ensure their availability to needy patients as well as to avoid unnecessary reaction and disease transmission due to whole blood transfusion. With increasing cost of health care delivery, the blood conservation programme will be a real challenge. Before I say good bye, let me remind the readers to send their valuable suggestions to improve this News Letter. These will be published.
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