General Nonblood Management Principles

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1. Formulate a detailed and individualized clinical management plan to minimize blood loss and treat anemia. Comprehensive prospective planning should make optimal use of a combination of modalities to prevent or respond to hemorrhage or anemia. A blood conservation program cannot depend on a single modality.
2. Obtain informed consent for anticipated or potential procedures. Discuss the risks and benefits (both short- and long-term) of proposed interventions with the patient/family.
3. Considering the risk of transfusion and available blood management options, refer patient to another institution if better resources are available elsewhere.
4. Employ a multidisciplinary team approach. Collaborate with other disciplines to develop the most appropriate blood management strategy. Communicate management plan to all team members, assigning clear roles and responsibilities. Maintain ongoing communication regarding patient management, especially where there are multiple conditions treated by multiple physicians.
5. Maintain surveillance for blood loss or physiological deterioration. Early recognition and involvement of appropriate senior staff and prompt action to prevent/control abnormal bleeding are essential. The threshold for intervention should be lower than for patients who will accept allogeneic blood transfusion.
6. Prompt action to secure hemostasis in the actively bleeding patient who refuses blood transfusion is lifesaving. Use diagnostic tests that will provide rapid results, minimize delays, and thus reduce blood loss. In general, avoid a “watch and wait” approach to the bleeding patient.
7. Exercising clinical judgment, be prepared to modify routine practice when conditions change.
8. Consult promptly with senior specialists with experience in managing patients without allogeneic transfusion at an early stage if complications arise.
9. Transfer a stabilized patient, if necessary, to a major center before the patient’s condition deteriorates.

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Clinical Strategies for Avoiding and Controlling Hemorrhage and Anemia Without Blood Transfusion in Surgical Patients a

a This Clinical Strategies document is an informational resource and reference for medical practitioners only. It provides neither medical advice nor treatment recommendations and does not substitute for an appropriately qualified health-care professional. The editor does not recommend or endorse any test, physician, product, or procedure, and has endeavored to include accurate, timely information. However, not all listed strategies are appropriate or acceptable to all patients. It is the responsibility of each provider to maintain awareness of new information, discuss options for care, and assist patients in making choices in accord with their wishes, values, and beliefs. Patients should always seek the advice of a qualified health-care professional regarding a medical condition or treatment.