1 Introduction
Patient blood management aims to improve clinical outcomes by avoiding unnecessary exposure to blood components. It includes the three pillars of:
- optimisation of blood volume and red cell mass
- minimisation of blood loss
- optimisation of the patient’s tolerance of anaemia.
These principles apply in the management of any haematological disorder. Patient blood management optimises the use of donor blood and reduces transfusion-associated risk.
This document, Patient Blood Management Guidelines: Module 2 –Perioperative is the second in a series of six modules that focus on evidence-based patient blood management. This module aims to support the introduction of patient blood management practices in the perioperative setting. The other five modules are listed in , below. Together, the six modules will supersede the 2001 National Health and Medical Research Council/Australasian Society of Blood Transfusion (NHMRC/ASBT) Clinical Practice Guidelines on the Use of Blood Components. 1
Revision of the 2001 guidelines1 was needed because of:
- increasing evidence of transfusion-related adverse outcomes, leading to the emergence of new practices, including restrictive transfusion strategies and the increased use of alternatives to transfusion in the management of anaemia
- variable (and frequently poor) compliance with the recommendations of the 2001 guidelines, indicated by a high degree of variation in transfusion practices
- failure of the 2001 guidelines to address a range of clinical settings where blood management is commonly required, including critical bleeding and massive transfusion, chronic medical conditions, obstetrics and paediatrics.
This document is intended to inform health-care practitioners, health educators, and health service managers and policy makers about the pre, intra and postoperative care of patients undergoing surgery or invasive procedures, particularly those in which blood loss is anticipated. Transfusion decisions for patients should take into account each individual’s clinical circumstances and physiological status, and their treatment preferences and choices.
If blood components are likely to be indicated, transfusion should not be a default decision. Instead, the decision on whether to transfuse should be carefully considered, taking into account the full range of available therapies, and balancing the evidence for efficacy and improved clinical outcome against the potential risks (Appendix B).