Blood Res.  2024;59:21. 10.1007/s44313-024-00021-x.

Preoperative consultation for determining the appropriate transfusion strategy

• Kang K

• KMID: 2562525
• DOI: http://doi.org/10.1007/s44313-024-00021-x

Abstract

Surgical patients are at risk of postoperative complications and mortality, necessitating preoperative patient optimiza‑ tion through the identification and correction of modifiable risk factors. Although preoperative platelet transfusions aim to reduce the risk of bleeding, their efficacy remains uncertain. Similarly, red blood cell transfusion in patients with anemia does not reduce the risk of postoperative mortality and may exacerbate complications. Therefore, devel‑ oping individualized strategies that focus on correcting preoperative complete blood count abnormalities and mini‑ mizing transfusion requirements are essential. This review aimed to examine complete blood count abnormalities and appropriate transfusion strategies to minimize postoperative complications.

Keyword

Preoperative care; Anemia; Thrombocytopenia; Blood transfusion; Patient blood management

Figure

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  Fig. 1 Screening and related work-up for preoperative anemia

• 

  Fig. 2 The Fick equation applied to assess anemia

Reference

1. Healey MA, Shackford SR, Osler TM, Rogers FB, Burns E. 2002; Complications in surgical patients. Arch Surg. 137:611–8. https://doi.org/10.1001/archsurg.137.5.611. DOI: 10.1001/archsurg.137.5.611. PMID: 11982478.

2. Dharap SB, Barbaniya P, Navgale S. 2022; Incidence and risk factors of postoperative complications in general surgery patients. Cureus. 14:e30975. https://doi.org/10.7759/cureus.30975. DOI: 10.7759/cureus.30975. PMID: 36465229. PMCID: PMC9714582.

3. van Kooten RT, Bahadoer RR, Peeters KCMJ, et al. 2021; Preoperative risk factors for major postoperative complications after complex gastrointestinal cancer surgery: a systematic review. Eur J Surg Oncol. 47:3049–58. https://doi.org/10.1016/j.ejso.2021.07.021. DOI: 10.1016/j.ejso.2021.07.021. PMID: 34340874.

4. Collins R, Scrimgeour A, Yusuf S, Peto R. 1988; Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med. 318:1162–73. https://doi.org/10.1056/nejm198805053181805. DOI: 10.1056/NEJM198805053181805. PMID: 3283548.

5. Macpherson CR, Jacobs P, Dent DM. 1993; Abnormal peri-operative haemorrhage in asymptomatic patients is not predicted by laboratory testing. S Afr Med J. 83:106–8. PMID: 8451684.

6. Suchman AL, Mushlin AI. 1986; How well does the activated partial thromboplastin time predict postoperative hemorrhage? JAMA. 256:750–3. DOI: 10.1001/jama.256.6.750. PMID: 3723774.

7. Bryson GL. 2005; Has preoperative testing become a habit? Can J Anaesth. 52:557–61. https://doi.org/10.1007/bf03015762. DOI: 10.1007/BF03015762. PMID: 15983138.

8. Pollmann H, Richter H, Ringkamp H, Jürgens H. 1999; When are children diagnosed as having severe haemophilia and when do they start to bleed? A 10-year single-centre PUP study. Eur J Pediatr. 158:S166–70. https://doi.org/10.1007/pl00014347. DOI: 10.1007/PL00014347. PMID: 10650861.

9. Kim KY, Yang CH, Cho MJ, Lee M. 1988; Comprehensive clinical and statistical analysis of hemophilia in Korea. J Korean Med Sci. 3:107–15. https://doi.org/10.3346/jkms.1988.3.3.107. DOI: 10.3346/jkms.1988.3.3.107. PMID: 3079565. PMCID: PMC3053653.

10. Lassandro G, Palladino V, Faleschini M, et al. 2022; "CHildren with Inherited Platelet disorders Surveillance" (CHIPS) retrospective and prospective observational cohort study by Italian Association of Pediatric Hematology and Oncology (AIEOP). Front Pediatr. 10:967417. https://doi.org/10.3389/fped.2022.967417. DOI: 10.3389/fped.2022.967417. PMID: 36507135. PMCID: PMC9728612. PMID: 134bacc0158c4a0281db481c045b7b63.

11. Shim YJ. 2020; Genetic classification and confirmation of inherited platelet disorders: current status in Korea. Clin Exp Pediatr. 63:79–87. https://doi.org/10.3345/kjp.2019.00052. DOI: 10.3345/kjp.2019.00052. PMID: 31477680. PMCID: PMC7073384. PMID: d11f7b5bb38a4d1cb52bc44e797ff39d.

12. Kim B. 2022; Diagnostic workup of inherited platelet disorders. BR. 57:S11–9. https://doi.org/10.5045/br.2022.2021223. DOI: 10.5045/br.2022.2021223. PMID: 35483920. PMCID: PMC9057669.

13. Tasu JP, Vesselle G, Herpe G, et al. 2015; Postoperative abdominal bleeding. Diagn Interv. Imaging. 96:823–31. https://doi.org/10.1016/j.diii.2015.03.013. DOI: 10.1016/j.diii.2015.03.013. PMID: 26078019.

14. Lawson JW, Kitchens CS. Kitchens CS, Kessler CM, Konkle BA, Streiff MB, Garcia DA, editors. 2019. 34 - Surgery and hemostasis. Consultative Hemostasis and Thrombosis. 4th ed. Elsevier;Philadelphia: p. 696–720. DOI: 10.1016/B978-0-323-46202-0.00034-0.

15. Konkle BA. Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J, editors. 2022. Bleeding and Thrombosis. Harrison's Principles of Internal Medicine, 21e. McGraw-Hill Education;https://accessmedicine.mhmedical.com/content.aspx?bookid=3095§ionid=262792022.Accessed5June2024. DOI: 10.1097/00007611-195101000-00027.

16. Uhl L, Assmann SF, Hamza TH, Harrison RW, Gernsheimer T, Slichter SJ. 2017; Laboratory predictors of bleeding and the effect of platelet and RBC transfusions on bleeding outcomes in the PLADO trial. Blood. 130:1247–58. https://doi.org/10.1182/blood-2017-01-757930. DOI: 10.1182/blood-2017-01-757930. PMID: 28679741. PMCID: PMC5606003.

17. Slichter SJ, Kaufman RM, Assmann SF, et al. 2010; Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med. 362:600–13. https://doi.org/10.1056/NEJMoa0904084. DOI: 10.1056/NEJMoa0904084. PMID: 20164484. PMCID: PMC2951321.

18. Vlaar AP, Oczkowski S, de Bruin S, et al. 2020; Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med. 46:673–96. https://doi.org/10.1007/s00134-019-05884-8. DOI: 10.1007/s00134-019-05884-8. PMID: 31912207. PMCID: PMC7223433.

19. Patel IJ, Rahim S, Davidson JC, et al. 2019; Society of Interventional Radiology Consensus Guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 30:1168–84.e1. https://doi.org/10.1016/j.jvir.2019.04.017. DOI: 10.1016/j.jvir.2019.04.017. PMID: 31229333.

20. Curry NS, Davenport R, Pavord S, et al. 2018; The use of viscoelastic haemostatic assays in the management of major bleeding: a British Society for Haematology Guideline. Br J Haematol. 182:789–806. https://doi.org/10.1111/bjh.15524. DOI: 10.1111/bjh.15524. PMID: 30073664.

21. Kaufman RM, Djulbegovic B, Gernsheimer T, et al. 2015; Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 162:205–13. https://doi.org/10.7326/m14-1589. DOI: 10.7326/M14-1589. PMID: 25383671.

22. Stanworth SJ, Shah A. 2022; How I use platelet transfusions. Blood. 140:1925–36. https://doi.org/10.1182/blood.2022016558. DOI: 10.1182/blood.2022016558. PMID: 35926105.

23. Koch CG, Li L, Sun Z, et al. 2017; From bad to worse: anemia on admission and hospital-acquired anemia. J Patient Saf. 13:211–6. https://doi.org/10.1097/pts.0000000000000142. DOI: 10.1097/PTS.0000000000000142. PMID: 25290084.

24. Muñoz M, Gómez-Ramírez S, Campos A, Ruiz J, Liumbruno GM. 2015; Pre-operative anaemia: prevalence, consequences and approaches to management. Blood Transfus. 13:370–9. https://doi.org/10.2450/2015.0014-15. DOI: 10.2450/2015.0014-15. PMID: 26192787. PMCID: PMC4614288.

25. Leal-Noval SR, Muñoz-Gómez M, Jiménez-Sánchez M, et al. 2013; Red blood cell transfusion in non-bleeding critically ill patients with moderate anemia: is there a benefit? Intensive Care Med. 39:445–53. https://doi.org/10.1007/s00134-012-2757-z. DOI: 10.1007/s00134-012-2757-z. PMID: 23184038.

26. Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB. 2012; Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg. 147:49–55. https://doi.org/10.1001/archsurg.2011.790. DOI: 10.1001/archsurg.2011.790. PMID: 22250113.

27. Fowler AJ, Ahmad T, Phull MK, Allard S, Gillies MA, Pearse RM. 2015; Meta-analysis of the association between preoperative anaemia and mortality after surgery. Br J Surg. 102:1314–24. https://doi.org/10.1002/bjs.9861. DOI: 10.1002/bjs.9861. PMID: 26349842.

28. Ferraris VA, Hochstetler M, Martin JT, Mahan A, Saha SP. 2015; Blood transfusion and adverse surgical outcomes: the good and the bad. Surgery. 158:608–17. https://doi.org/10.1016/j.surg.2015.02.027. DOI: 10.1016/j.surg.2015.02.027. PMID: 26032824.

29. Lin Y. 2019; Preoperative anemia-screening clinics. Hematology Am Soc Hematol Educ Program. 2019:570–6. https://doi.org/10.1182/hematology.2019000061. DOI: 10.1182/hematology.2019000061. PMID: 31808909. PMCID: PMC6913451.

30. Goodnough LT, Maniatis A, Earnshaw P, et al. 2011; Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines. Br J Anaesth. 106:13–22. https://doi.org/10.1093/bja/aeq361. DOI: 10.1093/bja/aeq361. PMID: 21148637. PMCID: PMC3000629.

31. Kotzé A, Harris A, Baker C, et al. 2015; British Committee for Standards in Haematology Guidelines on the Identification and Management of Pre-Operative Anaemia. Br J Haematol. 171:322–31. https://doi.org/10.1111/bjh.13623. DOI: 10.1111/bjh.13623. PMID: 26343392.

32. Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. 2017; Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016. Eur J Anaesthesiol. 34:332–95. https://doi.org/10.1097/eja.0000000000000630. DOI: 10.1097/EJA.0000000000000630. PMID: 28459785.

33. Del Vecchio L, Locatelli F. 2016; An overview on safety issues related to erythropoiesis-stimulating agents for the treatment of anaemia in patients with chronic kidney disease. Expert Opin Drug Saf. 15:1021–30. https://doi.org/10.1080/14740338.2016.1182494. DOI: 10.1080/14740338.2016.1182494. PMID: 27149639.

34. Cho BC, Serini J, Zorrilla-Vaca A, et al. 2019; Impact of preoperative erythropoietin on allogeneic blood transfusions in surgical patients: results from a systematic review and meta-analysis. Anesth Analg. 128:981–92. https://doi.org/10.1213/ane.0000000000004005. DOI: 10.1213/ANE.0000000000004005. PMID: 30649068.

35. Kei T, Mistry N, Curley G, et al. 2019; Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis. Can J Anaesth. 66:716–31. https://doi.org/10.1007/s12630-019-01351-6. DOI: 10.1007/s12630-019-01351-6. PMID: 30924000.

36. Kim HJ, Hwang S-H, Oh H-B, Ko D-H. 2023; Transfusion thresholds: the need for a patient-centered approach in hematologic disorders that require chronic transfusion therapy. BR. 58:S8–10. https://doi.org/10.5045/br.2023.2023009. DOI: 10.5045/br.2023.2023009. PMID: 36843379. PMCID: PMC10133846.