PERIOPERATIVE PATIENT BLOOD MANAGEMENT

Anemia and its treatment using red blood cell (RBC) transfusions are known to be the risk factors for posto­perative morbidity and mortality. These disadvantages led to the need for an approach that supports the proper and timely evaluation and management of anemia as well as a rational utilization of blood products. In recent de­cades, the World Health Organization (WHO) advoca­ted Patient Blood Management (PBM), which focuses on the patient’s own blood as a resource that should be conserved and managed appropriately, and the avoidance of irrational use of blood transfusions. The implemen­tation of PBM in the perioperative period is based on 3 pillars: 1. the optimization of the erythrocyte volume, through early detection of anemia before surgery, its pro­per management, and evaluation of applied treatment; 2. minimization of blood loss, by limiting blood drawn for blood testing, adhering to adequate anesthetic principles to maintain hemodynamics, using blood-sparing surgical techniques, implementing viscoelastic methods for the evaluation of blood, and prescribing antifibrinolytics; 3. optimization of the patient’s physiological tolerance toward anemia and rational usage of blood transfusion, which can be achieved by ensuring optimized cardiac output, minimized oxygen consumption, and maximi­zed oxygen delivery to tissues as well as following a restrictive RBC transfusion strategy.