Estratégias clínicas estruturadas como alternativas à transfusão de sangue em adultos: impactos em mortalidade, sangramento e complicações clínicas

Abstract

Blood transfusion is widely used in the management of patients with bleeding and anemia; however, it is associated with clinical and immunological risks, as well as ethical limitations in individuals who refuse it due to personal or religious beliefs. This systematic review aimed to analyze the scientific evidence regarding the safety, efficacy, and clinical outcomes of alternative strategies to blood transfusion in adults. To this end, searches were conducted in the LILACS, MEDLINE/PubMed, SciELO, Scopus, and Web of Science databases, using standardized DeCS/MeSH descriptors and Boolean operators. Original and observational studies published within the last ten years were included, evaluating structured clinical interventions such as optimization of erythropoiesis, pharmacological management of hemostasis, Patient Blood Management protocols, and molecular engineering–based alternatives in both surgical and non-surgical settings, excluding studies restricted to emergency care. Study selection and data extraction were performed by independent reviewers, in accordance with PRISMA 2020 recommendations, including an analysis of the study’s relevance. Overall, the included studies demonstrated that alternative strategies to transfusion are safe and effective, being associated with lower mortality, reduced infectious complications, and shorter hospital length of stay, without impairment of functional recovery. It is concluded that structured transfusion-free clinical management represents a viable, evidence-based approach and should be considered both for patients who refuse transfusion and for those at higher risk of adverse events related to allogeneic blood.