Perioperative Anemia Management.

Anemia is increasingly recognized as an interventional hematological target in patients before major surgery. Preoperative anemia increases the need for perioperative blood transfusion, and there is now a well-recognized association with increased patient complications, length of hospital stay, and worse outcomes. Patient Blood Management (PBM) is a World Health Organization endorsed, evidence-based management bundle of care in transfusion hemostasis that focuses on three main aspects: anemia management, prevention of blood loss, and appropriate transfusion practice. Implementation of PBM guidelines has been accompanied by reduced transfusion needs and improved patient outcomes. In a patient presenting with preoperative anemia or at risk of transfusion, this should initiate a program of PBM that manages the patient through the entire operative period. We review the current evidence on the three pillars of PBM and highlight those aspects with the strongest evidence in support of their impact.

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Déclaration de conflit d'intérêts

Dr. Richards reports grants from the National Institute for Health Research (NIHR) Health Technology Assessment, National Health and Medical Research Council, National Institute of Academic Anaesthesia BJA/ACTA/VASGBI; grants, personal fees, and nonfinancial support from Pharmacosmos, Vifor Pharma; grants and personal fees from Acelity; grants from NIHR Efficacy and Mechanism Evaluation; personal fees from Amgen, Medtronic, and Tiash Ltd., outside the submitted work. He is a regular speaker at national and international conferences on anemia, blood transfusion, wound healing, and vascular diseases for which he has received expenses for travel, accommodation, and sundries. He has worked with several agencies promoting meetings or health care. He is the director of the Iron Clinic Ltd. and Veincare London Ltd. He is also the vascular lead for 18-week wait Ltd. Dr. Abeysiri reports personal fees and other fees toward a conference from Vifor Pharma, outside the submitted work.