Advertisement
Review Article| Volume 41, ISSUE 1, P161-174, March 2023

Patient Blood Management, Anemia, and Transfusion Optimization Across Surgical Specialties

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Anesthesiology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Shander A.
        • Hardy J.F.
        • Ozawa S.
        • et al.
        A global definition of patient blood management.
        Anesth Analg. 2022; 135: 476-488
      1. World Health Organization. 2011. Available at: https://apps.who.int/iris/bitstream/handle/10665/85839/WHO_NMH_NHD_MNM_11.1_eng.pdf?sequence=22&isAllowed=y. Accessed June 14, 2022.

        • Migone De Amicis M.
        • Poggiali E.
        • Motta I.
        • et al.
        Anemia in elderly hospitalized patients: prevalence and clinical impact.
        Intern Emerg Med. 2015; 10: 581-586
        • Muñoz M.
        • Gómez-Ramírez S.
        • Campos A.
        • et al.
        Pre-operative anaemia: prevalence, consequences and approaches to management.
        Blood Transfus. 2015; 13: 370-379
        • Warner M.A.
        • Shore-Lesserson L.
        • Shander A.
        • et al.
        Perioperative Anemia: Prevention, Diagnosis, and Management Throughout the Spectrum of Perioperative Care.
        Anesth Analg. 2020; 130: 1364-1380
        • van der Laan S.
        • Billah T.
        • Chi C.
        • et al.
        Anaemia among intensive care unit survivors and association with days alive and at home: an observational study.
        Anaesthesia. 2021; 76: 1352-1357
        • Warner M.A.
        • Hanson A.C.
        • Frank R.D.
        • et al.
        Prevalence of and Recovery From Anemia Following Hospitalization for Critical Illness Among Adults.
        JAMA Netw Open. 2020; 3: e2017843
        • Warner M.A.
        • Kor D.J.
        • Frank R.D.
        • et al.
        Anemia in Critically Ill Patients With Acute Respiratory Distress Syndrome and Posthospitalization Physical Outcomes.
        J Intensive Care Med. 2021; 36: 557-565
        • Warner M.A.
        • Hanson A.C.
        • Schulte P.J.
        • et al.
        Early Post-Hospitalization Hemoglobin Recovery and Clinical Outcomes in Survivors of Critical Illness: A Population-Based Cohort Study.
        J Intensive Care Med. 2022; 37: 1067-1074
        • Moretti D.
        • Goede J.S.
        • Zeder C.
        • et al.
        Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women.
        Blood. 2015; 126: 1981-1989
        • Stoffel N.U.
        • Cercamondi C.I.
        • Brittenham G.
        • et al.
        Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials.
        Lancet Haematol. 2017; 4: e524-e533
        • Stoffel N.U.
        • Zeder C.
        • Brittenham G.M.
        • et al.
        Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women.
        Haematologica. 2020; 105: 1232-1239
        • Muñoz M.
        • Acheson A.G.
        • Auerbach M.
        • et al.
        International consensus statement on the peri-operative management of anaemia and iron deficiency.
        Anaesthesia. 2017; 72: 233-247
        • Mueller M.M.
        • Van Remoortel H.
        • Meybohm P.
        • et al.
        Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference.
        JAMA. 2019; 321: 983-997
        • Phrommintikul A.
        • Haas S.J.
        • Elsik M.
        • et al.
        Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis.
        Lancet. 2007; 369: 381-388
        • Pfeffer M.A.
        • Burdmann E.A.
        • Chen C.Y.
        • et al.
        A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease.
        N Engl J Med. 2009; 361: 2019-2032
        • Aapro M.
        • Scherhag A.
        • Burger H.U.
        Effect of treatment with epoetin-beta on survival, tumour progression and thromboembolic events in patients with cancer: an updated meta-analysis of 12 randomised controlled studies including 2301 patients.
        Br J Cancer. 2008; 99: 14-22
        • Spahn D.R.
        • Schoenrath F.
        • Spahn G.H.
        • et al.
        Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial.
        Lancet. 2019; 393: 2201-2212
        • Feagan B.G.
        • Wong C.J.
        • Kirkley A.
        • et al.
        Erythropoietin with iron supplementation to prevent allogeneic blood transfusion in total hip joint arthroplasty. A randomized, controlled trial.
        Ann Intern Med. 2000; 133: 845-854
        • Weltert L.
        • Rondinelli B.
        • Bello R.
        • et al.
        A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial.
        Transfusion. 2015; 55: 1644-1654
        • Kosmadakis N.
        • Messaris E.
        • Maris A.
        • et al.
        Perioperative erythropoietin administration in patients with gastrointestinal tract cancer: prospective randomized double-blind study.
        Ann Surg. 2003; 237: 417-421
        • Devalia V.
        • Hamilton M.S.
        • Molloy A.M.
        • et al.
        Guidelines for the diagnosis and treatment of cobalamin and folate disorders.
        Br J Haematol. 2014; 166: 496-513
        • Barile L.
        • Fominskiy E.
        • Di Tomasso N.
        • et al.
        Acute normovolemic hemodilution reduces allogeneic red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis of randomized trials.
        Anesth Analg. 2017; 124: 743-752
        • Mladinov D.
        • Eudailey K.W.
        • Padilla L.A.
        • et al.
        Effects of acute normovolemic hemodilution on post-cardiopulmonary bypass coagulation tests and allogeneic blood transfusion in thoracic aortic repair surgery: An observational cohort study.
        J Cardiovasc Surg. 2021; 36: 4075-4082
        • Mladinov D.
        • Padilla L.A.
        • Leahy B.
        • et al.
        Hemodilution in high-risk cardiac surgery: Laboratory values, physiological parameters, and outcomes.
        Transfusion. 2022; 62: 826-837
        • Park L.
        • Gilbert R.
        • Baker L.
        • et al.
        The safety and efficacy of hypovolemic phlebotomy on blood loss and transfusion in liver surgery: a systematic review and meta-analysis.
        HPB (Oxford). 2020; 22: 340-350
        • Shander A.
        • Corwin H.L.
        A narrative review on hospital-acquired anemia: keeping blood where it belongs.
        Transfus Med Rev. 2020; 34: 195-199
        • Levy J.H.
        • Koster A.
        • Quinones Q.J.
        • et al.
        Antifibrinolytic therapy and perioperative considerations.
        Anesthesiology. 2018; 128: 657-670
        • Devereaux P.J.
        • Marcucci M.
        • Painter T.W.
        • et al.
        Tranexamic acid in patients undergoing noncardiac surgery.
        N Engl J Med. 2022; 386: 1986-1997
        • Adams R.C.
        • Lundy J.S.
        Anesthesia in cases of poor surgical risk: some suggestions for decreasing the risk.
        Anesthesiology. 1942; 3: 603-607
        • Hebert P.C.
        • Wells G.
        • Blajchman M.A.
        • et al.
        A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care.
        N Engl J Med. 1999; 340: 409-417
        • Walsh T.S.
        • Boyd J.A.
        • Watson D.
        • et al.
        Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial.
        Crit Care Med. 2013; 41: 2354-2363
        • Holst L.B.
        • Haase N.
        • Wetterslev J.
        • et al.
        Lower versus higher hemoglobin threshold for transfusion in septic shock.
        N Engl J Med. 2014; 371: 1381-1391
        • ASA
        Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management∗.
        Anesthesiology. 2015; 122: 241-275
        • Vlaar A.P.
        • Oczkowski S.
        • de Bruin S.
        • et al.
        Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine.
        Intensive Care Med. 2020; 46: 673-696
        • Napolitano L.M.
        • Kurek S.
        • Luchette F.A.
        • et al.
        Clinical practice guideline: red blood cell transfusion in adult trauma and critical care.
        Crit Care Med. 2009; 37: 3124-3157
        • Trentino K.M.
        • Farmer S.L.
        • Isbister J.P.
        • et al.
        Restrictive Versus Liberal Transfusion Trials: Are They Asking the Right Question?.
        Anesth Analg. 2020; 131: 1950-1955
        • Will N.D.
        • Kor D.J.
        • Frank R.D.
        • et al.
        Initial Postoperative Hemoglobin Values and Clinical Outcomes in Transfused Patients Undergoing Noncardiac Surgery.
        Anesth Analg. 2019; 129: 819-829
      2. American College of Surgery. Trauma Quality Improvement Program. Massive Transfusion in Trauma Guidelines. 2014. Available at: https://www.facs.org/media/zcjdtrd1/transfusion_guildelines.pdf. Accessed May 28, 2022.

      3. ACOG. Practice Bulletin No. 183: Postpartum Hemorrhage.
        Obstet Gynecol. 2017; 130: e168-e186
        • Cannon J.W.
        • Khan M.A.
        • Raja A.S.
        • et al.
        Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma.
        J Trauma acute Care Surg. 2017; 82: 605-617
        • Ducrocq G.
        • Gonzalez-Juanatey J.R.
        • Puymirat E.
        • et al.
        Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial.
        JAMA. 2021; 325: 552-560
        • Mazer C.D.
        • Whitlock R.P.
        • Fergusson D.A.
        • et al.
        Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery.
        N Engl J Med. 2018; 379: 1224-1233
        • Lasocki S.
        • Pene F.
        • Ait-Oufella H.
        • et al.
        Management and prevention of anemia (acute bleeding excluded) in adult critical care patients.
        Ann Intensive Care. 2020; 10: 97
        • Hovaguimian F.
        • Myles P.S.
        Restrictive versus Liberal Transfusion Strategy in the Perioperative and Acute Care Settings: A Context-specific Systematic Review and Meta-analysis of Randomized Controlled Trials.
        Anesthesiology. 2016; 125: 46-61
        • Griffiths R.
        • Babu S.
        • Dixon P.
        • et al.
        Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists.
        Anaesthesia. 2021; 76: 225-237
        • Bergamin F.S.
        • Almeida J.P.
        • Landoni G.
        • et al.
        Liberal versus restrictive transfusion strategy in critically Ill oncologic patients: the transfusion requirements in critically ill oncologic patients randomized controlled trial.
        Crit Care Med. 2017; 45: 766-773
        • Tay J.
        • Allan D.S.
        • Chatelain E.
        • et al.
        Liberal Versus Restrictive Red Blood Cell Transfusion Thresholds in Hematopoietic Cell Transplantation: A Randomized, Open Label, Phase III, Noninferiority Trial.
        J Clin Oncol. 2020; 38: 1463-1473
        • Desjardins P.
        • Turgeon A.F.
        • Tremblay M.H.
        • et al.
        Hemoglobin levels and transfusions in neurocritically ill patients: a systematic review of comparative studies.
        Crit Care. 2012; 16: R54
        • Gobatto A.L.N.
        • Link M.A.
        • Solla D.J.
        • et al.
        Transfusion requirements after head trauma: a randomized feasibility controlled trial.
        Crit Care. 2019; 23: 89
        • Carson J.L.
        • Noveck H.
        • Berlin J.A.
        • et al.
        Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion.
        Transfusion. 2002; 42: 812-818
        • Shander A.
        • Javidroozi M.
        • Naqvi S.
        • et al.
        An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME).
        Transfusion. 2014; 54 (; quiz 2687): 2688-2695
        • Shander A.
        • Javidroozi M.
        • Gianatiempo C.
        • et al.
        Outcomes of Protocol-Driven Care of Critically Ill Severely Anemic Patients for Whom Blood Transfusion Is Not an Option.
        Crit Care Med. 2016; 44: 1109-1115
        • Weiskopf R.B.
        • Viele M.K.
        • Feiner J.
        • et al.
        Human cardiovascular and metabolic response to acute, severe isovolemic anemia.
        JAMA. 1998; 279: 217-221
        • Leung J.M.
        • Weiskopf R.B.
        • Feiner J.
        • et al.
        Electrocardiographic ST-segment changes during acute, severe isovolemic hemodilution in humans.
        Anesthesiology. 2000; 93: 1004-1010
        • de Bruin S.
        • Scheeren T.W.L.
        • Bakker J.
        • et al.
        Transfusion practice in the non-bleeding critically ill: an international online survey-the TRACE survey.
        Crit Care. 2019; 23: 309
        • Zeroual N.
        • Blin C.
        • Saour M.
        • et al.
        Restrictive Transfusion Strategy after Cardiac Surgery.
        Anesthesiology. 2021; 134: 370-380
        • Fischer M.O.
        • Guinot P.G.
        • Debroczi S.
        • et al.
        Individualised or liberal red blood cell transfusion after cardiac surgery: a randomised controlled trial.
        Br J Anaesth. 2022; 128: 37-44
        • Fogagnolo A.
        • Taccone F.S.
        • Vincent J.L.
        • et al.
        Using arterial-venous oxygen difference to guide red blood cell transfusion strategy.
        Crit Care. 2020; 24: 160
        • Vlaar A.P.J.
        • Toy P.
        • Fung M.
        • et al.
        A consensus redefinition of transfusion-related acute lung injury.
        Transfusion. 2019; 59: 2465-2476
        • Goel R.
        • Patel E.U.
        • Cushing M.M.
        • et al.
        Association of Perioperative Red Blood Cell Transfusions With Venous Thromboembolism in a North American Registry.
        JAMA Surg. 2018; 153: 826-833
        • Fatalities F.D.A.
        Reported to FDA Following Blood Collection and Transfusion.
        (Available at:) (Accessed May 14, 2022)
        • Bosboom J.J.
        • Klanderman R.B.
        • Migdady Y.
        • et al.
        Transfusion-Associated Circulatory Overload: A Clinical Perspective.
        Transfus Med Rev. 2019; 33: 69-77
        • National C.D.C.
        Healthcare Safety Network Biovigilance Component Hemovigilance Module Surveillance Protocol.
        in: CDC NHSN biovigilance component. 2021 (Available at:) (Accessed May 15, 2022)
        • van den Akker T.A.
        • Grimes Z.M.
        • Friedman M.T.
        Transfusion-associated circulatory overload and transfusion-related acute lung injury.
        Am J Clin Pathol. 2021; 156: 529-539
        • Parmar N.
        • Pendergrast J.
        • Lieberman L.
        • et al.
        The association of fever with transfusion-associated circulatory overload.
        Vox Sang. 2017; 112: 70-78
        • Blumberg N.
        • Heal J.M.
        • Gettings K.F.
        • et al.
        An association between decreased cardiopulmonary complications (transfusion-related acute lung injury and transfusion-associated circulatory overload) and implementation of universal leukoreduction of blood transfusions.
        Transfusion. 2010; 50: 2738-2744
        • Clifford L.
        • Jia Q.
        • Subramanian A.
        • et al.
        Risk factors and clinical outcomes associated with perioperative transfusion-associated circulatory overload.
        Anesthesiology. 2017; 126: 409-418
        • Menis M.
        • Anderson S.A.
        • Forshee R.A.
        • et al.
        Transfusion-associated circulatory overload (TACO) and potential risk factors among the inpatient US elderly as recorded in Medicare administrative databases during 2011.
        Vox Sang. 2014; 106: 144-152
        • Gupta S.P.
        • Nand N.
        • Gupta M.S.
        • et al.
        Haemodynamic changes following blood transfusion in cases of chronic severe anemia: increased safety with simultaneous furosemide administration.
        Angiology. 1983; 34: 699-704
      4. US Food and Drug Administration. 2016. Available at: https://www.fda.gov/media/111226/download. Accessed April 27, 2022.

        • Prevention CfDCa
        National Healthcare Safety Network Biovigilance Component, Hemovigilance Module.
        Surveill Protoc. 2021;
        • Peters A.L.
        • Van Stein D.
        • Vlaar A.P.
        Antibody-mediated transfusion-related acute lung injury; from discovery to prevention.
        Br J Haematol. 2015; 170: 597-614
        • McVey M.J.
        • Kapur R.
        • Cserti-Gazdewich C.
        • et al.
        Transfusion-related Acute Lung Injury in the Perioperative Patient.
        Anesthesiology. 2019; 131: 693-715
        • Bux J.
        Transfusion-related acute lung injury (TRALI): a serious adverse event of blood transfusion.
        Vox Sang. 2005; 89: 1-10
        • Chapman C.E.
        • Stainsby D.
        • Jones H.
        • et al.
        Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma.
        Transfusion. 2009; 49: 440-452
        • Reesink H.W.
        • Lee J.
        • Keller A.
        • et al.
        Measures to prevent transfusion-related acute lung injury (TRALI).
        Vox Sang. 2012; 103: 231-259
        • Goldberg A.D.
        • Kor D.J.
        State of the art management of transfusion-related acute lung injury (TRALI).
        Curr Pharm Des. 2012; 18: 3273-3284
        • Cata J.P.
        • Wang H.
        • Gottumukkala V.
        • et al.
        Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions.
        Br J Anaesth. 2013; 110: 690-701
        • Vamvakas E.C.
        Possible mechanisms of allogeneic blood transfusion-associated postoperative infection.
        Transfus Med Rev. 2002; 16: 144-160
        • Simancas-Racines D.
        • Osorio D.
        • Martí-Carvajal A.J.
        • et al.
        Leukoreduction for the prevention of adverse reactions from allogeneic blood transfusion.
        Cochrane Database Syst Rev. 2015; 12: CD009745
        • Amato A.
        • Pescatori M.
        Perioperative blood transfusions for the recurrence of colorectal cancer.
        Cochrane Database Syst Rev. 2006; 1: CD005033
        • Wu H.L.
        • Tai Y.H.
        • Lin S.P.
        • et al.
        The Impact of Blood Transfusion on Recurrence and Mortality Following Colorectal Cancer Resection: A Propensity Score Analysis of 4,030 Patients.
        Sci Rep. 2018; 8: 13345
        • Rohde J.M.
        • Dimcheff D.E.
        • Blumberg N.
        • et al.
        Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis.
        JAMA. 2014; 311: 1317-1326
        • Raghavan M.
        • Marik P.E.
        Anemia, allogenic blood transfusion, and immunomodulation in the critically ill.
        Chest. 2005; 127: 295-307
        • Weber W.P.
        • Zwahlen M.
        • Reck S.
        • et al.
        The association of preoperative anemia and perioperative allogeneic blood transfusion with the risk of surgical site infection.
        Transfusion. 2009; 49: 1964-1970
        • Guinn N.R.
        • Fuller M.
        • Murray S.
        • et al.
        Treatment through a preoperative anemia clinic is associated with a reduction in perioperative red blood cell transfusion in patients undergoing orthopedic and gynecologic surgery.
        Transfusion. 2022; 62: 809-816
        • Richards T.
        • Baikady R.R.
        • Clevenger B.
        • et al.
        Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial.
        Lancet. 2020; 396: 1353-1361