BLOODLESS MEDICINE and SURGERY
The Growing Demand

Fluids: Ringer's lactate solution, dextran, hydroxyethyl starch, and others are used to maintain blood volume, preventing hypovolemic shock. Some fluids now being tested can transport oxygen.

Drugs: Genetically engineered proteins can stimulate the production of red blood cells (erythropoietin), blood platelets (interleukin-11), and various white blood cells (GM-CSF, G-CSF). Other medications greatly reduce blood loss during surgery (aprotinin, antifibrinolytics) or help to reduce acute bleeding (desmopressin).

Biological hemostats: Collagen and cellulose woven pads are used to stop bleeding by direct application. Fibrin glues and sealants can plug puncture wounds or cover large areas of bleeding tissue.

Blood salvage: Salvaging machines recover blood that is lost during surgery or trauma. The blood is cleansed and can be returned to the patient in a closed circuit. In extreme cases, liters of blood can be recovered using such a system.

Surgical techniques: Thorough operative planning, including consultation with experienced clinicians, helps the surgical team to avoid complications. Prompt action to stop bleeding is essential. Delays greater than 24 hours can greatly increase patient mortality. Dividing large surgeries into several smaller ones decreases total blood loss.

Surgical tools: Some devices cut and seal blood vessels simultaneously. Other devices can seal bleeding on large areas of tissue. Laparoscopic and minimally invasive instruments allow surgeries to be performed without the blood loss associated with large incisions.