**Cardiac Surgery and Allogeneic Blood Transfusions**

Yavuz M. Bilgin

*Department of Hematology, Erasmus Medical Center Rotterdam The Netherlands* 

#### **1. Introduction**

146 Perioperative Considerations in Cardiac Surgery

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Bakaeen. Staged Versus Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting: Analysis of 10-Year Nationwide Outcomes. Ann Thorac Coronary artery bypass graft (CABG) surgery is a frequently performed intervention for revascularization of the myocardium. Worldwide approximately 1,000,000 patients are undergoing cardiac surgery annually. Nowadays more older patients with more comorbidities are operated, which is possible due to more advanced techniques. Herewith allogeneic blood transfusions play a crucial role in performing of these more complicated treatments. Until the discovery of the AB0-bloodgroups in the early 1900s allogeneic blood transfusions were a high-risk procedure: more than 50% of the recipients of blood died. The discovery of the blood groups followed by the development of citrate as anticoagulant to prevent clotting of blood enabled the start of safer transfusion medicine. Both World Wars and other disasters in the 20th century had a large impact on further development and structural organization of transfusion medicine. Before the introduction of centrifugation techniques in the 1960s whole blood transfusions were used. Since transfusion of red blood cells, platelet concentrates and plasma became possible over time, treatment of more diseases and opportunities for surgical interventions raised. Nowadays due to stringent donor selection and advanced preparation techniques transfusions of blood components became gradually considered as a safe therapy. From the blood components, red blood cells are used for blood loss and other causes of anemia, while plasma and platelets are transfused to treat or as prophylaxis for bleeding disorders. However unexpected adverse effects leading to more transfusion-related complications are the reasons of serious concerns, which resulted in more evidence-based research aiming to reduce the risks of allogeneic blood transfusions. Nowadays in the Western World every year about 50-70 per 1,000 patients receive a blood transfusion (Cobain et al., 2007), while at the age of 80 years approximately one in five persons has been transfused (Kamper-Jorgensen et al., 2009). Per year 75 millions of blood units are collected and transfused worldwide, thereby yearly saving thousands of lives, facilitating more complex surgery as cardiac surgery and making transfusion of different blood components indispensable for treatment of many diseases. The development of modern transfusion medicine represents one of the greatest achievements of medicine in the 20th century. However the safety of allogeneic blood transfusions is high, there are still risks leading to higher morbidity and mortality associated with blood transfusions. Many clinical and laboratory studies are performed in the past years to decrease the risks of allogeneic blood transfusions.
