JAMA: new recommendations on perioperative blood management


  • Mary Corcoran
  • Univadis Medical News
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An international panel of experts who took part in the 2018 Patient Blood Management (PBM) International Consensus Conference has established new clinical recommendations for pre-operative anaemia, red blood cell (RBC) transfusion thresholds for adults and implementation of PBM programmes. 

The major clinical recommendations include:  

  • Detection and management of pre-operative anaemia early enough before major elective surgery. 
  • Use of iron supplementation to reduce RBC transfusion rate in adult pre-operative patients with iron-deficient anaemia undergoing elective surgery. 
  • Erythropoiesis-stimulating agents should not be used routinely for adult pre-operative patients with anaemia undergoing elective surgery. 
  • Consider short-acting erythropoietins in addition to iron supplementation in adult pre-operative patients with haemoglobin levels less than 13 g/dL undergoing elective major orthopaedic surgery to reduce transfusion rates.
  • Restrictive RBC transfusion threshold (haemoglobin concentration
  • Restrictive RBC transfusion threshold (haemoglobin concentration
  • Restrictive transfusion threshold (haemoglobin concentration
  • Restrictive transfusion threshold (haemoglobin concentration 7-8 g/dL) in haemodynamically stable patients with acute gastrointestinal bleeding. 

The authors noted the quality of evidence in general was moderate to very low. 

The full recommendations are published in JAMA.