Patient Blood Management: Anesthesiologist's Perspectives

Blood transfusion is generally considered to be the solution of anemia and blood loss during surgery. Transfusion is a very efficient and effective method to correct anemia, but there has been increasing evidence that blood transfusion does not lead to improved outcomes and that morbidity and mortality increase in a dose-dependent manner [1,2]. It has been shown that even a single unit of transfused packed red blood cells (PRBCs) can increase 30day mortality, complicated mortality, pneumonia and sepsis [3]. Therefore, it is preferable to avoid unnecessary blood transfusion or to minimize blood transfusion. In surgical patients, patient blood management focuses on anemia management, minimization of blood loss, appropriate transfusion for reducing surgical risk, and improving patient outcome after surgery. Recognition and management of pre-operative anemia represent an opportunity to optimize patient status before surgery, thereby reducing blood transfusion and potentially improving recovery from surgery and associated postoperative outcomes. A complex approach such as anesthetic strategy and operative techniques, pharmacological intervention, and cell salvage is required to reduce bleeding during surgery. In this review, we reviewed the studies about blood management in the stance of anesthesiologists. Management of coagulopathy and blood component therapy was not included in this review.