Resuscitation: Perioperative Blood Management

Pre-operative Identification and Treatment of Anemia

• Preoperative anemia can be as high as 40% (check ferritin and Tsat)
• Primarily due to iron deficiency and chronic disease.
• Risk factors for iron deficiency: poor diet, NSAID use.
• Is the single most treatable risk factor for a blood transfusion (iron supplementation and EPO
• Note: EPO poses a risk of increased mortality in cancer patients

Intra-operative

• Minimize Blood Loss: Maintain body temperature, pH.
• Controlled hypotension was previously advocated for surgeries in vessel rich areas such as the nose. However, there is little evidence to support its routine use.
• In combination with anemia, hypotension increases the risk of tissue ischemia and should be avoided
• Intraoperative Cell Salvage:
• Shed blood is suctioned, anticoagulated, centrifuged and returned to patient.
• May be acceptable to some Jehovah Witness.
• There is a risk of coagulopathy due to ↓platelets and coagulation factor
• Contraindicated in cancer and if there is intra-operative potential for bacterial, ascitic or amniotic contamination

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