Box 3.

Methods of minimising transfusion

Preoperative planning

• History and examination including surgical or bleeding history
• Full blood count, “group and save,” blood chemistry, coagulation, haematinics
• Consider autologous blood deposit
• Consider erythropoietin to boost haemoglobin concentration
• Treat iron or folate deficiency
• Stop aspirin prophylaxis if possible

Day of admission

• Check if taking aspirin, non-steroidal anti-inflammatory drugs, anticoagulants
• Repeat full blood count and “group and save”
• Weigh patient, calculate blood volume, and estimate blood loss that would reduce packed cell volume to 0.22
• Consider acute normovolaemic haemodilution and intraoperative or postoperative cell salvage
• Consider drugs to reduce bleeding (such as aprotinin)

During surgery

• Be prepared for longer duration to secure haemostasis
• Consider hypotensive surgery if appropriate
• Avoid hypothermia—give all fluids through a warmer
• Use of near patient testing
• Consider fibrin glues and sealants

Postoperative care

• Accept lower postoperative haemoglobin concentration
• Accept transfusions of just one unit of blood, to exceed transfusion trigger
• Use continuous face mask oxygen if patient has low haemoglobin concentration
• Prescribe iron and folic acid routinely
• Consider tranexamic acid