| Evaluations | Interventions for individuals with relevant findings |
| Preoperative |
| Screen for anemia (ideally at four weeks before planned surgery) | - Address treatable causes of anemia, such as iron deficiency or vitamin B12 deficiency.
- Determine need for erythropoietin.
- Delay elective high blood loss surgery (anticipated >500 mL) until cause of anemia can be addressed and appropriate therapy instituted.
|
| Ask about bleeding history | - Develop multidisciplinary plan for hemostatic therapy for patients with hemostatic disorders.
|
| For patients receiving anticoagulants, determine thrombotic and bleeding risks | - Follow current recommendations for anticoagulant discontinuation and re-initiation.
|
| Determine expected blood loss | - Prepare to use intraoperative blood salvage* for those with expected blood loss >1000 mL.
|
| Confirm patient wishes regarding transfusion therapy and blood conservation modalities | - For those for whom blood transfusion is not an option (eg, JW), clarify which secondary components (eg, clotting factor concentrates) are acceptable and under what circumstances (if any) wishes would change. (Refer to ASA consent and recommendations for patients for whom blood is not an option.)
- For those for whom blood transfusion is not an option, develop multidisciplinary plan to address preoperative anemia, coagulation defects, and blood loss.
|
| Intraoperative |
| All patients | - Maintain euvolemia (large volumes of crystalloid solution are typically avoided).
- Avoid hypothermia.
- Use meticulous hemostatic technique.
- Topical hemostatic agents when appropriate.
|
| Expected large surgical blood loss >1000 mL | - Use intraoperative blood salvage* if appropriate.
- Administer an antifibrinolytic agent if appropriate.
- Use evidence-based transfusion guidelines.
- Possible use of ANH.
|
| Postoperative |
| All patients | - Minimize blood sampling.
- Use evidence-based transfusion guidelines.
|
| Excessive bleeding | - Early surgical re-exploration for those with localized internal bleeding.
- Cell salvage in selected cases with large external blood loss.
- Laboratory testing and hematology input for those with diffuse bleeding.
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| Anemia | - Evaluation for iron deficiency in selected cases (eg, preoperative anemia or microcytosis that was not evaluated; excessive blood loss).
- Ongoing treatment and follow-up.
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