Canterbury DHB

Context

The adult patient requiring elective surgery who declines blood products– ‘bloodless surgery’

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Bloodless surgery refers to the co-ordinated peri-operative care of patients aiming to avoid blood transfusion and improve patient outcomes [6]. The three pillars of bloodless surgery are maximising pre-operative haemoglobin, minimising blood loss and accepting post-operative anaemia.

The patient’s wishes need to be made clear to the surgeon and anaesthetist prior to any scheduling of surgery and a discussion regarding the potential complications of surgery including bleeding risk should take place. The surgical team can advise on available minimally invasive/traumatic techniques [6]. This discussion should be clearly documented in the patient's clinical notes.

Please refer to flowchart: Elective Surgery for Patients who Decline Blood Products.

The two major predictors of peri-operative blood transfusion that can be influenced are type of surgical procedure and pre-operative haemoglobin.

Generally, blood loss tends to be less with laparoscopic versus open surgery. Longer procedures result in more blood loss. See Estimating the maximum allowable blood loss (MABL).

In This Section

Bloodless surgery: Maximising the pre-operative haemoglobin level

Bloodless surgery: Estimating the maximum allowable blood loss (MABL)

Bloodless surgery: Reducing blood loss

Bloodless surgery: Post operative anaemia

Bloodless surgery: Maximising the pre-operative haemoglobin level

Early measurement of haemoglobin, investigation and treatment of underlying anaemia is crucial.

Bloodless surgery: Estimating the maximum allowable blood loss (MABL)

The estimated blood loss for the procedure in question, in conjunction with an estimation of the maximum allowable blood loss resulting in a post-operative haemoglobin level, can help with planning and influence the necessity of certain interventions e.g. need for erythropoietin. Please see Maximum Allowable Blood Loss Relating to Post-Operative Haemoglobin.

Bloodless surgery: Reducing blood loss

Pre-operative measures

Intra-operative measures

Bloodless surgery: Post operative anaemia

The haemoglobin threshold at which post-operative red cell transfusion is warranted is controversial. A randomised trial published in Dec 2011 compared liberal and restrictive transfusion strategies after hip surgery in over 2000 patients >50 years at high cardiovascular risk and found that a liberal transfusion strategy did not reduce rates of death or ability to walk independently on 60-day follow-up or reduce in-hospital morbidity [10].

Post-operative care:

About this Canterbury DHB document (47843):

Document Owner:

Julia Czuprynska and Richard Seigne (see Who's Who)

Issue Date:

August 2014

Next Review:

August 2016

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 47843