Perioperative Patient Blood Management

Preoperative anaemia affects 30–60% of patients presenting for major surgery and is an independent risk factor associated with increased blood transfusions, postoperative complications, delayed discharge and increased mortality. Patient blood management (PBM) is built on the 'three pillars': optimise erythropoiesis; minimise blood loss (surgical) and bleeding (coagulopathic); and harness and optimise physiological reserve of anaemia. In this chapter, the authors review how the three pillars of PBM can be implemented within the preoperative, intraoperative and postoperative periods. Transfusion of packed red cells has historically been the solution for anaemia in the perioperative period. Blood transfusion is an independent risk factor for perioperative morbidity and mortality in surgical patients. Future research needs to be directed towards providing higher levels of evidence-based medicine for PBM.