Perioperative Blood Management
This chapter describes the management of blood during surgery. Blood management refers to the practice of minimizing allogeneic blood use, while maximizing patient outcome. Blood management has four main points: a focus on guideline-driven proper use of banked blood and minimizing its appropriate use, pharmaceutical preparations that prevent, minimize or control blood loss, usually in the operative setting, blood conservation methods and a multidisciplinary approach. Blood conservation includes preoperative, intraoperative and postoperative techniques. The strongest predictor of a patient requiring blood during an elective surgery is his or her baseline hematocrit, with other significant contributing factors being the patient's blood volume and red blood cell loss during the procedure. Optimizing the patient's hemoglobin prior to surgery will decrease the chance of transfusion and iron or erythropoietin may be indicated depending on the cause of the patient's anemia. Preoperative anemia additionally increases the risk of perioperative infection and mortality, which may be secondary to the associated risk of allogeneic blood transfusion. © 2009 Elsevier Inc. All rights reserved.
