3.1 Effect of a perioperative patient blood management program

The aim of this question was to establish the effect of a coordinated, multidisciplinary patient blood management program on clinical outcomes and blood component use in surgical patients.

The evidence for this question was obtained from one Level I study,11 five Level III studies12–16 and one Level IV study.17 All of these studies were assessed as being of poor quality. They employed a variety of elements within a patient blood management program; however, all used an approach that was coordinated by either an individual or a group.

In all patients undergoing surgery, the primary objectives should be preoperative optimisation of red cell mass and coagulation status; minimisation of perioperative blood loss, including meticulous attention to surgical haemostasis; and tolerance of postoperative anaemia.

EVIDENCE STATEMENT – for perioperative patient blood management program	Evidence	Consistency	Clinical impact	Generalisability	Applicability
A multidisciplinary, multimodal programmatic approach to perioperative blood management is associated with a reduction in transfusion requirements during cardiac or noncardiac surgery. The effect of such programs on morbidity and mortality is uncertain.	X

(See Table 2.2)

RECOMMENDATION for perioperative patient blood management program

R1 Grade C	Health-care services should establish a multidisciplinary, multimodal perioperative patient blood management program (Grade C). This should include preoperative optimisation of red cell mass and coagulation status; minimisation of perioperative blood loss, including meticulous attention to surgical haemostasis; and tolerance of postoperative anaemia.