3 Clinical guidance

• 3.1 Effect of a perioperative patient blood management program
• 3.2 Effect of anaemia on outcomes
• 3.3 Effect of red blood cell transfusion on outcomes
• 3.3.1 Effect of red blood cell transfusion
• 3.3.2 Effect of liberal versus restrictive red blood cell transfusion protocols
• 3.4 Effect of non-transfusion interventions to increase haemoglobin concentration
• 3.4.1 Effect of iron therapy
• 3.4.2 Effect of erythropoiesis-stimulating agents
• 3.5 Cessation of medications that affect haemostasis
• 3.5.1 Cardiac surgery
• 3.5.2 Noncardiac surgery or other invasive procedures
• 3.6 Effect of perioperative strategies that minimise blood loss
• 3.6.1 Preoperative autologous donation
• 3.6.2 Prevention of hypothermia
• 3.6.3 Appropriate patient positioning
• 3.6.4 Deliberate induced hypotension
• 3.6.5 Acute normovolemic haemodilution
• 3.6.6 Intraoperative cell salvage
• 3.6.7 Perioperative acute normovolemic haemodilution combined with intraoperative cell salvage
• 3.6.8 Point-of-care testing
• 3.6.9 Administration of antifibrinolytics and desmopressin
• 3.6.10 Postoperative cell salvage
• 3.7 Triggers for blood component transfusion
• 3.8 Effect of blood components on outcomes
• 3.8.1 Effect of fresh frozen plasma
• 3.8.2 Effect of cryoprecipitate or fibrinogen concentrate
• 3.8.3 Effect of platelet transfusion
• 3.9 Effect of recombinant activated factor VII on outcomes

This chapter provides clinical guidance in the form of recommendations (based on evidence) and practice points (based on CRG consensus). The guidance is organised around the nine questions that formed the basis of the systematic review. Full details of the findings of the systematic review are given in the accompanying technical report.

This chapter also outlines the need for an algorithm to assess and optimise perioperative haemoglobin (Appendix F), which can be used as a guide to suit the local patient population and health-care resources.