Perioperative Transfusion Medicine, 2nd Edition. By Bruce D. Spiess, M.D., Richard K. Spence, M.D., F.A.C.S., and Aryeh Shander, M.D., F.C.C.M., F.C.C.P. Philadelphia, Lippincott Williams & Wilkins, 2006. Pages: 697. Price: $129.00.
Two anesthesiologists (Bruce D. Spiess, M.D., Professor of Anesthesiology and Emergency Medicine, Director VCURES—Shock Center, Virginia Commonwealth University Medical Center, Richmond, Virginia; and Aryeh Shander, M.D., F.C.C.M., F.C.C.P., Clinical Professor of Internal Medicine and Anesthesiology, Mount Sinai School of Medicine, New York, New York, Chief, Departments of Anesthesiology, Critical Care Medicine, Pain Management, and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, New Jersey) and a surgeon (Richard K. Spence, M.D., F.A.C.S., Senior Vice President for Clinical Affairs, Infonalé, Inc., West Chester, Pennsylvania) edited the second edition of Perioperative Transfusion Medicine . They state in the preface that it is largely new and wholly different from the first edition published in 1998. The majority of the 60 contributors are anesthesiologists, surgeons, or transfusion medicine/blood banking specialists. Forty percent of the chapters are authored or coauthored by the editors.
The book is divided into 11 sections. The introductory section is devoted to the history and economics of transfusion, the blood supply, ethics, and standards of practice. The section titled The Physiologic Basis for Blood Management: A New Look begins with a chapter on oxygen transport monitoring as the basis for developing transfusion triggers and continues with discussions of the physiology of anemia and erythrocyte transfusion, physiology of hemostasis, platelet physiology and cellular and protein interactions, iron metabolism and erythropoiesis, and another chapter on oxygen transport. Section 3 is devoted to transfusion risks (infection, immunomodulation, and acute reactions). Most references in this section are from the transfusion medicine literature, providing anesthesiologists with clinically relevant information from sources they ordinarily would not read. Although the first chapter in the Blood Component Therapy section indicates it is a surgeon’s guide to blood banking and transfusion medicine, it is equally suitable for anesthesiologists. The section Alternatives to Allogeneic Blood covers preoperative autologous donation, erythropoietin therapy, hemoglobin-based oxygen carriers, and perfluorocarbon emulsions. The two sections devoted to trauma and the bleeding patient and coagulation issues contain 11 chapters. The chapter on perioperative coagulation monitoring begins with a review of coagulation (discussed in two other chapters) and continues with descriptions of coagulation monitoring devices and their clinical applications. The four chapters in the Anesthesia Considerations section are devoted to anesthetic techniques in blood conservation, erythrocyte salvage and autotransfusion, acute normovolemic hemodilution, and hypothermia and hemorrhage. Among the chapters in the section titled Transfusion and Surgical Subspecialties are one on surgery in patients with erythrocyte disorders and another on surgery in Jehovah’s Witnesses. Cardiac and vascular surgery and solid organ transplantation also are discussed. Obstetrics and gynecology, pediatric surgery, oncologic surgery, and neurosurgery are considered in the following section.
The last section, titled Postoperative Transfusion Issues, contains four chapters, written by the editors, which they describe as the heart of the book. In the chapter dealing with transfusion and outcome, they emphasize the lack of randomized studies and the paucity of data documenting the benefits of transfusion. After summarizing and critiquing the available studies examining relations between transfusion and outcome, they conclude that the data often indicate transfusion seems to worsen outcome—not improve it. The chapter by Drs. Shander and Spiess titled The Transfusion Decision is identical to the one by Drs. Spiess, Counts, and Gould in the first edition. When referring to other chapters, they use chapter numbers from the first edition—not the new edition! This is surprising in view of their claim in the preface that the entire concept of transfusion for surgical patients has undergone a revolution since the publication of the first edition, and the promise of an up-to-date assessment of the thinking involved in transfusion decisions. Some of the information is outdated and conflicts with that in other chapters. Two brief chapters, one on undertransfusion and another explaining their philosophy of blood management, follow. The latter contains 16 points clinicians should remember when considering transfusion. Among them are the importance of using clinical criteria, not number-based triggers, for transfusion; using blood conservation techniques and alternatives to allogeneic transfusion; following transfusion guidelines (not cookbook orders); and administering the safest available products, one unit at a time. One cannot argue with their philosophy.
As with any multiauthored book, there is a great deal of repetition. It seems contributors were not given (or did not follow) guidelines regarding what they should and should not cover and topics to be discussed by other contributors. For example, acute normovolemic hemodilution is discussed in seven consecutive chapters even though it is covered adequately in the chapter devoted to it. The incidence of transfusion-transmitted infectious disease is discussed in six chapters; the risks cited differ among chapters.
The authors included contributions from virtually every category of healthcare provider involved in transfusing patients in the perioperative period (anesthesiologists, surgeons, transfusion medicine specialists and blood bank personnel, critical care physicians, hematologists, perfusionists, and nurses) as well as others representing special interests (Jehovah’s Witnesses, blood collection and distribution organizations, and blood management programs). The chapters on the physiology of anemia and erythrocyte transfusion, transfusion risks, anesthetic techniques in blood conservation, and transfusion and outcome should be of particular interest to anesthesiologists. Transfusion decisions must be made thoughtfully, based on clinical evaluation of individual patients. That message is conveyed very clearly. However, it may not find its way to a great number of anesthesiologists. Most chapters written by and targeted to surgeons will not appeal to anesthesiologists. The same is true for those on economics, the blood supply, blood storage, quality control and hospital blood use, and iron metabolism and erythropoiesis. Nevertheless, the book deserves a place in departmental libraries as a reference source. It provides information not readily available elsewhere.
Scottsdale, Arizona. lindastehling@cox.net
