Anaemia and blood transfusion: incorporating patient blood management

Both red blood cell (RBC) transfusion and anaemia or low haematocrit increase morbidity and mortality associated with surgery. Chronic anaemia in the elective patient carries a small risk in non-haemorrhagic surgery. Where bleeding is anticipated anaemia should be treated medically to avoid (RBC) transfusion which will increase the risk to the patient. Major bleeding (MB) has the biggest impact on adverse outcomes. Acute anaemia is caused by surgical bleeding and requires RBC transfusion to keep the haematocrit (Hct) above 21% and haemoglobin (Hb) above 7 g/dl in patients without coronary artery disease (CAD) and between Hct 24–27% or Hb >8 g/dl in patients with CAD. Having a patient blood management programme can mitigate the problem. Medical, surgical and anaesthetic planning are paramount to avoid bleeding and transfusion which together have a significant impact on adverse outcomes for the patient.