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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