Patient Blood Management

Preoperative identification of high-risk patients should be performed, and all available preoperative and perioperative measures of blood conservation should be undertaken in this group as they account for the majority of blood products transfused. (AI)

Assessment of anemia and determination of its etiology is appropriate in all patients undergoing cardiac surgery, and it is reasonable to treat with intravenous iron preparations if time permits. (B-RIIa)

In patients undergoing cardiac operations, it is reasonable to implement standardized transfusion protocols in order to reduce transfusion burden. (B-RIIa)

In patients who have (i) preoperative anemia, (ii) refuse blood transfusion, (iii) or are deemed high-risk for postoperative anemia, it is reasonable to administer preoperative erythropoietin-stimulating agents and iron supplementation several days prior to cardiac operations to increase red cell mass. (B-RIIa)

Minimization of phlebotomy by reduced volume and frequency of blood sampling is a reasonable means of blood conservation. (B-NRIIa)

Preoperative treatment of asymptomatic anemia and thrombocytopenia with transfusion is of uncertain benefit. (B-NRIII (no benefit))