Blood use varies widely for very similar operations
In planned surgery there are wide variations in the use of blood for the same operations done by different surgical teams. Some units now routinely perform major surgical procedures with little or no transfusion. This is achieved by a commitment to good blood management, with attention to all the details of the patient’s care that together can avoid the need to transfuse. Specific blood-sparing procedures, such as blood salvage, play a part, but their effect on reducing transfusion may be small when the surgical team already practices good blood management. More information on surgical blood conservation can be found at Better Blood Transfusion Toolkit, www.nataonline.com/ and www.sabm.org/
Table 6 Outline of perioperative blood management for elective surgery
Manage haemoglobin level
Blood salvage and transfusion
Preadmission clinic assessment
Correct anaemia (see Anaemia).
Increase erythropoiesis with haematinics and epoetin if indicated.
Detect and manage haemostatic defects (see Bleeding problems).
Stop anti coagulants and anti-platelet drugs if safe to do so (see Table 7).
Arrange for blood salvage to be available if it is appropriate for the planned operation (see Intra-operative blood salvage).
Surgical and anaesthetic techniques
Measured haematocrit or blood loss as a guide to red cell replacement.
Keep the patient warm as cold impairs blood clotting.
Rapid haemostasis testing to guide blood component replacement.
Antifibrinolytic drug where surgical loss is expected to be high (see Aprotinin).
Intra-operative blood salvage.
Minimise blood loss and control transfusion
Protocol to guide when haemoglobin should be checked.
Minimise blood taken for laboratory samples.
Protocol to trigger re-exploration at specified level of blood loss.
Post-operative blood salvage.
Guideline or protocol specifying blood transfusion thresholds and targets.
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