Preoperative assessment clinics are becoming increasingly used prior to elective surgery in order to ensure that the patient is appropriately prepared before their hospital admission. To support and encourage good practice, The British Orthopaedic Society has published a booklet on blood conservation that includes a section on Preoperative Management. The document can be downloaded here or visit the BOA website: www.boa.ac.uk.
A short document 'Integrating good transfusion practice into pre-operative assessment clinics' (pdf) has been prepared by Mel Westmoreland (Transfusion Liaison Nurse - South Central) on behalf of the Appropriate Use of Blood Group. It is designed to highlight some of the key points to consider when planning the effective and appropriate use of blood in pre-operative care planning.
Any assessment undertaken when a patient is referred for an elective surgical procedure must take account of issues specific to blood conservation to reduce the need for blood transfusion. There is a requirement for attention to detail and planning during preoperative assessment, and the perioperative and post operative periods.
Preoperative Planning (six weeks prior to surgery):
- Full History and examination to include current medication and a bleeding history
- Full blood count
- Group and antibody screen
- Blood chemistry as appropriate
- Haematinics assay / clotting screen if the history or the proposed procedure suggests that blood loss is likely. (see Guideline for assessment of bleeding risk prior to surgery or invasive procedures. BCSH approved document (www.bcshguidelines.com).
- The prescription of iron and folic acid.
- Stopping aspirin, clopidogrel or warfarin prior to the proposed procedure if appropriate.
- The use of low molecular weight heparin (LMWH).
- Inform the patient regarding:
- The possible use of intra or postoperative cell salvage
- The needs of patients who do not wish to accept transfusion e.g. Jehovah’s Witness (information can be found in the Handbook of Transfusion Medicine, Appendix 3).
Further information can be found in the Handbook of Transfusion Medicine, Planned surgery.
This page was last reviewed on 01/09/2010