Clinical strategies to avoid blood transfusion

A multifactorial approach to anaesthesia and surgery can reduce the requirements for perioperative allogeneic blood transfusion. First, the patient is optimized preoperatively to ensure the RBC mass is maximized. This process may include treatment with iron, folate, B12 or erythropoietin. Preoperative autologous blood donation may be appropriate for some patient groups. Intraoperative anaesthetic techniques include acute normovolaemic haemodilution, careful patient positioning, the use of regional anaesthesia where appropriate, avoidance of hypertension and use of controlled hypotension, and RBC salvage. These are combined with appropriate surgical techniques such as minimally invasive surgery, use of tourniquets where possible, and coagulating dissecting instruments. This multifactorial approach is necessary because of the known inherent risks of allogeneic blood transfusion, and also because of the increased pressure on the precariously balanced UK blood supply.