Table 1 Current strategies for perioperative blood conservation

1. Pharmacological therapies

a. Antifibrinolytic drugs (aprotinin, tranexamic acid, epsilon-aminocaproic acid)

b. Desmopressin acetate

c. Recombinant factor VIIa (rFVIIa)

d. Erythropoietin (EPO)

e. Topical haemostatic agents

2. Autologous blood transfusion

a. Preoperative autologous blood donation

b. Acute normovolemic hemodilution

c. Red cell salvage (intraoperative and postoperative)

3. Anesthetic techniques

a. Controlled hypotension

b. Spinal or epidural anesthesia

c. Central venous pressure (CVP) manipulation

4. Surgical techniques

a. Coagulation diathermy devices, lasers, and ultrasonic scalpels

b. Minimally invasive surgery

c. Endoscopic and laparoscopic surgery

5. Blood substitutes

a. Solutions of modified hemoglobin

b. Perfluorocarbon emulsions

6. Transfusion protocols, guidelines, and clinical audit