Patient Blood Management: Anesthesiologist's Perspectives / 한양의대학술지

ABSTRACT

Preoperative anemia should be diagnosed and treated before surgery, because anemia is associated with increased postoperative mortality and morbidity. Even if iron deficiency is not detected, the possibility of functional iron deficiency should be considered. During surgery, patients should be managed to avoid hypothermia, acidosis, and hypocalcemia, while maintaining adequate blood pressure and preventing dilutional coagulopathy. It is currently recommended to start transfusion when hemoglobin is under 7–8 g/dL in patients without cardiac problems, using restrictive strategy rather than liberal, due to dangers of complications from transfusion. For those who refuse transfusion, or when transfusion is difficult due to multiple antibodies, or when attempting to reduce allogeneic transfusion, preoperative autologous blood donation (PAD), intraoperative acute normovolemic hemodilution (ANH), intraoperative blood salvage, or postoperative blood salvage can be used. For patients with trauma or massive bleeding, damage control resuscitation of permissive hypotension, restriction of crystalloid infusion, transfusion of blood product in a ratio similar to whole blood (111 of FFP, platelets, PRBC) must be actively carried out.