Optimal management of perioperative anemia: current perspectives

Abstract: Anemia is prevalent in surgical patients and is associated with increased morbidity and mortality. Allogeneic blood transfusions have long been the first choice in addressing the perioperative anemia in surgical patients. Such transfusions have been shown to adversely influence clinical outcome, prolong hospital stay, and increase complications and costs. Evidence of benefit from red blood cell (RBC) transfusion is hard to find, and most benefit from RBC transfusion is assumed and not scientifically proven. As such, perioperative anemia bears a significant clinical and economic impact on the health care landscape. Blood management relies on sustainable and cost-efficient interventions individualized to each patient and risk level. Restrictive transfusion triggers coupled to a multimodal strategy for reducing blood loss should be adopted as the standard of care in surgical patients. The approach aims at optimizing patient preoperative status and RBC stock as well as minimizing perioperative blood loss. Keywords: blood management, allogeneic, autologous, transfusion, erythropoietin, tranexamic acid, reinfusion, surgery