Perioperative transfusion practice

Anemia, thrombocytopenia, and derangements in coagulation parameters are common in the perioperative setting. This chapter discusses anemia, its impact on surgical outcomes, preoperative anemia optimization; the impact of red blood cell transfusions on surgical patient outcomes; the utility of preoperative hemostatic testing; and anti platelet therapies. Preoperative hemostatic assessment is important to ensure that patients at-risk for abnormal procedure-related bleeding are identified, evaluated, and managed appropriately to minimize this risk. Management of anticoagulation in the perioperative period can be challenging. Minimizing phlebotomy volumes has been previously demonstrated to reduce transfusion requirements in critically ill patients and should be a standard measure employed as part of blood avoidance. Topical hemostatic therapies offer a variety of options to manage localized bleeding that could prevent the need for transfusion. Strong definitive evidence to support an approach to platelet transfusion in the cardiac surgical patient remains sparse, and further investigations are warranted.