Blood conservation techniques in scoliosis surgery

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Blood conservation techniques have largely been implemented to improve outcomes of scoliosis surgery, though there still remains some debate as to which particular techniques should be implemented and how efficacious they are in avoiding allogeneic blood transfusion. The most common domains of blood conservation include autologous blood donation, cell salvage, normovolemic hemodilution, and intraoperative antifibrinolytic use. While autologous blood donation has been a staple of care among such techniques, recent research has suggested that it may not decrease the risk of allogeneic blood transplant, and may, in fact, increase the risk. Thus, it has largely been phased out in scoliosis surgery. Cell saving techniques are widely used and have largely demonstrated decreased transfusion necessity, thus warranting its continued use. Normovolemic hemodilution has limited data regarding its efficacy in scoliosis surgery, though some of the available data support its efficacy. Further research is required before any definitive recommendation can be made. Finally, antifibrinolytics clearly have a role in limiting blood loss in scoliosis surgery, with tranexamic acid serving as the most studied example. In conclusion, there is still no definitive answer to the question of how blood can be best conserved in the setting of scoliosis surgery, and effective treatment regimens should involve multiple strategies.

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