In the surgical setting the ‘risk of transfusion’ is magnified several fold in the presence of a subnormal pre-operative haemoglobin, whilst those going for elective surgery (e.g. hip replacement) with a mid to normal haemoglobin are unlikely to require blood.
A pre-operative haemoglobin of less than 12 g/dl increases the likelihood of transfusion threefold (British Orthopaedic Association 2005). The GP referral letter should identify any pre-existing problems of anaemia, bleeding tendencies, etc. Local referral protocols with GPs should incorporate the identification and treatment of anaemia prior to the initial Consultant outpatient consultation. If this is not possible, a full blood count should be performed at the time if the initial consultation. If a patient is identified as anaemic, then appropriate liaison should occur between the hospital and referring GP to investigate and/or treat underlying anaemia.
Diagnosis of a bleeding disorder
For further information on managing patients with bleeding problems see the Handbook of Transfusion Medicine, Table 7.
This page was last reviewed on 01/09/2010