Anaemia and blood transfusion incorporating patient blood management

Chronic anaemia in the stable patient carries a small risk in non-haemorrhagic surgery. Where bleeding is anticipated, anaemia can be treated medically to avoid transfusion. Both intravenous (IV) iron and erythropoiesis stimulating agents (ESA) are gaining popularity to raise the haemoglobin (Hb) in anaemic patients. Bleeding causes acute anaemia requiring maintenance of blood volume and only transfusion to keep the haematocrit (Hct) >21% and Hb >74 g/L in low-risk patients without coronary artery disease (CAD) and Hct 24–27% or Hb >80 g/L in high-risk patients. Both anaemia and transfusion increase the morbidity and mortality associated with surgery. The most significant impact on adverse outcomes is major bleeding (MB). Medical, surgical and anaesthetic management should focus on correcting anaemia and avoidance of bleeding to prevent adverse outcomes for the patient.