Perioperative Blood Management

Review previous medical records and interview the patient or family to identify:

• Previous blood transfusion.

• History of drug-induced coagulopathy (e.g., warfarin, clopidogrel, aspirin and other anticoagulants, as well as vitamins or herbal supplements that may affect coagulation)

• The presence of congenital coagulopathy.

• History of thrombotic events (e.g., deep vein thrombosis, pulmonary embolism).

• Risk factors for organ ischemia (e.g., cardiorespiratory disease) which may influence the ultimate transfusion trigger for red blood cells (e.g., hemoglobin level).

Inform patients of the potential risks versus benefits of blood transfusion and elicit their preferences.

Review available laboratory test results including hemoglobin, hematocrit, and coagulation profiles.

Order additional laboratory tests depending on a patient’s medical condition (e.g., coagulopathy, anemia).

Conduct a physical examination of the patient (e.g., ecchymosis, petechiae, pallor).

If possible, perform the preoperative evaluation well enough in advance (e.g., several days to weeks) to allow for proper patient preparation.