Anaemia and blood transfusion incorporating patient blood management

Chronic anaemia in the stable patient carries a small risk in non-haemorrhagic surgery. Where bleeding is anticipated, the risk increases. Management of anaemia preoperatively with haematinics may mitigate the risk but preoperative transfusion of even 1 unit of packed red blood cells (RBCs) increases the risk. The goal is to avoid perioperative blood transfusion. Preoperative oral iron from eight to three weeks before surgery remains the preferred option. Intravenous (IV) iron with or without erythropoiesis stimulating agents (ESAs) should be considered when oral iron fails or in specific patient groups. Bleeding causes acute anaemia requiring maintenance of blood volume and only transfusion to keep the haematocrit (Hct) >21% and haemoglobin (Hb) >74 g/L in low-risk patients without coronary artery disease (CAD) and Hct 24%–27% or Hb >80 g/L in high-risk patients. Both anaemia and transfusion increase the morbidity and mortality associated with surgery. The most significant impact on adverse outcomes is major bleeding (MB). Therefore medical, surgical and anaesthetic management should focus on correcting anaemia and minimizing blood loss to prevent adverse patient outcomes.