Blood conservation: Preoperative, perioperative, and postoperative blood management options

Perioperative blood loss during elective total joint arthroplasty (TJA) can be significant, traditionally resulting in high blood transfusion rates. However, due to the risks and costs of allogeneic blood transfusion, the focus in contemporary TJA has been on strategies to minimize perioperative blood loss. While a multimodal approach is paramount in elective TJA, three main factors have contributed dramatically to the reduced allogeneic blood transfusion rates: (1) preoperative assessment and treatment of anemia, (2) expanded use of antifibrinolytics, particularly tranexamic acid (TXA), and (3) a restrictive transfusion strategy postoperatively.