These Practice Guidelines update “Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies” adopted by the American Society of Anesthesiologists in 2005 and published in 2006. They provide new evidence obtained from the most recent scientific literature. The new Practice Guidelines include more emphasis on the preoperative assessment of the patient, assessment of the risk for transfusion, and the use of adjunct medications (e.g. erythropoietin to manage anaemia, prothrombin complex concentrate to reverse vitamin K antagonists, antifibrinolytics whenever appropriate) to prevent or treat bleeding.
The move towards patient blood management (PBM) is in line with the teachings of NATA over the past years. Somewhat surprising is the minimal role of preoperative iron therapy described in the recommendations. Nevertheless, it is encouraging to see that we have moved from simply applying a restrictive blood transfusion strategy to a more comprehensive approach of the (potentially anaemic) patient coming for a (potentially haemorrhagic) surgical procedure.
However, this approach (PBM) is not easy to implement in everyday practice since it means seeing patients well ahead of the operation, conducting a thorough evaluation and using all possible strategies (mainly pharmacologic) to correct preoperative anaemia and restore a normal red cell mass. In order to be successful, PBM will require the organised efforts of all those involved in the pre-, intra- and postoperative care of surgical patients.
– Jean-François Hardy