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World J Gastroenterol. Oct 7, 2009; 15(37): 4686-4694
Published online Oct 7, 2009. doi: 10.3748/wjg.15.4686
Blood transfusion for the treatment of acute anaemia in inflammatory bowel disease and other digestive diseases
José Antonio García-Erce, Fernando Gomollón, Manuel Muñoz
José Antonio García-Erce, Transfusion Medicine and Apheresis Unit, Haematology and Haemotherapy Regional Service, “Miguel Servet” University Hospital, Zaragoza 50009, Spain
Fernando Gomollón, Gastroenterology Unit, University Clinical Hospital and Biomedical Investigation Center at Digestive and Hepatic Disease Network, c/San Juan Bosco 15, Zaragoza 50009, Spain
Manuel Muñoz, Transfusion Medicine, School of Medicine, University of Málaga, Málaga 29071, Spain
Author contributions: All authors contributed equally to this work.
Supported by (In part) Grant ICS 08/0205 from Instituto Aragonés de Ciencias de la Salud (Zaragoza, Spain)
Correspondence to: Dr. José Antonio García-Erce, Transfusion Medicine and Apheresis Unit, Haematology and Haemotherapy Regional Service, “Miguel Servet” University Hospital, Zaragoza 50009, Spain. joseerce@ono.com
Telephone: +34-976-765546 Fax: +34-976-765545
Received: July 23, 2009
Revised: August 19, 2009
Accepted: August 26, 2009
Published online: October 7, 2009
Abstract

Allogeneic blood transfusion (ABT) is frequently used as the first therapeutic option for the treatment of acute anaemia in patients with inflammatory bowel disease (IBD), especially when it developed due to gastrointestinal or perioperative blood loss, but is not risk-free. Adverse effects of ABT include, but are not limited to, acute hemolytic reaction (wrong blood or wrong patient), febrile non-hemolytic transfusional reaction, bacterial contamination, transfusion-related acute lung injury, transfusion associated circulatory overload, transfusion-related immuno-modulation, and transmission of almost all infectious diseases (bacteria, virus, protozoa and prion), which might result in increased risk of morbidity and mortality. Unfortunately, the main physiological goal of ABT, i.e. to increase oxygen consumption by the hypoxic tissues, has not been well documented. In contrast, the ABT is usually misused only to increase the haemoglobin level within a fixed protocol [mostly two by two packed red blood cell (PRC) units] independently of the patient’s tolerance to normovolemic anaemia or his clinical response to the transfusion of PRC units according to a “one-by-one” administration schedule. Evidence-based clinical guidelines may promote best transfusion practices by implementing restrictive transfusion protocols, thus reducing variability and minimizing the avoidable risks of transfusion, and the use of autologous blood and pharmacologic alternatives. In this regard, preoperative autologous blood donation (PABD) consistently diminished the frequency of ABT, although its contribution to ABT avoidance is reduced when performed under a transfusion protocol. In addition, interpretation of utility of PABD in surgical IBD patients is hampered by scarcity of published data. However, the role of autologous red blood cells as drug carriers is promising. Finally, it must be stressed that a combination of methods used within well-constructed protocols will offer better prospects for blood conservation in selected IBD patients undergoing elective surgery.

Keywords: Anaemia; Blood transfusion; Autologous blood transfusion; Inflammatory bowel diseases; Risk assessment