title: Patient blood management to reduce surgical risk.
abstract: BACKGROUND
  Preoperative anaemia and perioperative blood transfusion are both identifiable and preventable surgical risks. Patient blood management is a multimodal approach to address this issue. It focuses on three pillars of care: the detection and treatment of preoperative anaemia; the reduction of perioperative blood loss; and harnessing and optimizing the patient-specific physiological reserve of anaemia, including restrictive haemoglobin transfusion triggers. This article reviews why patient blood management is needed and strategies for its incorporation into surgical pathways.
  
  
  METHODS
  Studies investigating the three pillars of patient blood management were identified using PubMed, focusing on recent evidence-based guidance for perioperative management.
  
  
  RESULTS
  Anaemia is common in surgical practice. Both anaemia and blood transfusion are independently associated with adverse outcomes. Functional iron deficiency (iron restriction due to increased levels of hepcidin) is the most common cause of preoperative anaemia, and should be treated with intravenous iron. Intraoperative blood loss can be reduced with antifibrinolytic drugs such as tranexamic acid, and cell salvage should be used. A restrictive transfusion practice should be the standard of care after surgery.
  
  
  CONCLUSIONS
  The significance of preoperative anaemia appears underappreciated, and its detection should lead to routine investigation and treatment before elective surgery. The risks of unnecessary blood transfusion are increasingly being recognized. Strategic adoption of patient blood management in surgical practice is recommended, and will reduce costs and improve outcomes in surgery.
authors: Division of Surgery and Interventional Science, University College London, London, UK.|Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, UK.
authors: B
authors: B
authors: Clevenger
authors: Division of Surgery and Interventional Science, University College London, London, UK.|Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free Hospital, London, UK.
authors: S V
authors: SV
authors: Mallett
authors: Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK.
authors: A A
authors: AA
authors: Klein
authors: Division of Surgery and Interventional Science, University College London, London, UK.
authors: T
authors: T
authors: Richards
mesh_terms: D000740:Anemia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D057234:Preoperative Period; D012307:Risk Factors; D065227:Transfusion Reaction