Patient Blood Management

Patient Blood Management describes a set of processes that aim to ↓ unnecessary transfusions by:

Anaemia is covered in detail under Anaemia Overview.

• Early detection and treatment of anaemia
• Minimising perioperative blood loss
• Improving post-operative tolerance to anaemia

Transfusion is associated with:

• Mortality:
  • Cardiac and non-cardiac surgery
  • Short-term and 5 year mortality
• Morbidity:
  • ↑ Length of stay
  • ↑ Postoperative infections
  • TRIM
• Cost

Minimising Perioperative Blood Loss

Preoperative

• Identifying and managing bleeding list
• Reviewing medications

Intraoperative:

• Surgical
  • Meticulous haemostasis
  • Topical haemostatics
• Anaesthetic
  • Avoid coagulopathy
    • Temperature ⩾35°C
    • pH ⩾7.2
    • iCa ⩾1mmol/L
  • Anaesthetic blood-sparing techniques
    Central neuraxial blockade reduces perioperative bleeding, especially in orthopaedics.
  • TXA
    If EBL ⩾500mL.
  • Cell salvage
    If EBL ⩾1L.

Postoperative

• Preventing secondary haemorrhage
• Minimising iatrogenic blood sampling
  • Reduce sample volumes
  • Using continuous sampling lines

Postoperative Anaemia Tolerance

• Maintain DO₂
  • Optimise CO
  • Optimise oxygenation and ventilation
  • Use appropriate transfusion thresholds
    
    • Hb 70g/dL in patients without underlying cardiac disease
    • Hb 80g/dL in patients with cardiac disease
    • Transfuse smallest volume possible
      i.e. Single units, if clinically appropriate.
• Minimise excess VO₂
  • Rapidly treat infections/sepsis

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References

1. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity.
2. Hughes, R, Khalafallah A, Aras, D. Perioperative iron deficiency anaemia – a review with a regional flavour. ANZCA Blue Book 2015.
3. Thakrar SV, Clevenger B, Mallett S. Patient blood management and perioperative anaemia. BJA Educ. 2017 Jan 1;17(1):28–34.