Patient Blood Management and Transfusion Strategies in Perioperative Settings

Recent years have witnessed an outstanding and impressive contribution of patient blood management strategies to global perioperative patient care, particularly with the implementation of pre-, per-, and post-operative strategies. The Management of blood transfusion in the perioperative period is of particular importance due to several reasons, including possible complications related to the use of blood products, not limited to immunizations, the risk of infection, Transfusion Acute Lung Injury (TRALI), electrolyte disturbances, and coagulopathy. Several years ago, the three pillars matrix for patient perioperative blood management was defined and included optimizing red cell mass, minimizing blood loss, and mobilizing and optimizing the physiological reserve of anaemia. (Isbister). Thus, different techniques and strategies were proposed in each pillar to be implemented either in the pre-, per, or postoperative period, aiming either to reduce blood loss, avoid the use of blood products, or use alternatives to allogeneic blood transfusion. These techniques include (and are not limited to) normovolemic haemodilution, autologous blood transfusion, pre-operative optimization using Iron with or without erythropoietin, the use of cell saver, and many more. In these management strategies, drugs such as Tranexamic acid are also useful tools. Among the remaining questions in the process were: to define the right product needed for the replacement therapy, the specific lab test needed to help such determination, and the ideal timing and protocol to decide on this replacement therapy. Whenever surgery would result in significant blood loss (typically 500-1000 ml or more), a discussion involving the surgical team and haemostasis expert is needed to design a targeted patient blood management strategy.

Major surgeries have been associated with higher blood loss. Depending on the pathophysiology of the patient's disease and comorbidities, the surgery type, the risk of significant blood loss, and the case complexity, many techniques have been proposed in different settings including all pediatric populations’ surgeries, cardiac, trauma-based, orthopedic, digestive surgeries, and obstetrics. The previous works have also led to the diversification of techniques and strategies, using techniques such as thromboelastography (TEG) and rotational thromboelastography (ROTEM). advantages of this latter technique include a shorter turnaround time, rapid decision-making, and guidance on the specific blood product, factor concentrate, or adjuvant needed. These techniques could be used alone or with specific decision algorithms targeting patient needs, procedures, hemostatic objectives, and possible alternatives to allogeneic blood transfusion. These technics and strategies can be implemented for all ages and might be used in various applications. An example of these management strategies was recently published in a review article on the advantages of Prothrombin complex concentrate (PCC) in the pediatric population in the failure of blood transfusion to achieve hemostasis and coagulation based on experiences in cardiac, trauma, and other coagulopathy scenarios, emphasizing particularly on Pediatric patients with congenital heart disease.



At this time, researchers are studying various algorithms and bundle strategies adapted to specific patients, and postoperative coagulopathy management strategies that could be used to optimize patient care. Others research areas are in perioperative blood transfusion management. In this research topic, we are seeking original papers from authors with articles focusing on the domain of perioperative blood management strategies and associated domains such as hemostasis and perioperative coagulation.