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Clinical Crossroads
November 2, 2011

Patient Blood ManagementA 68-Year-Old Woman Contemplating Autologous Blood Donation Before Elective Surgery

Author Affiliations

Author Affiliations: Dr Uhl is Director, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center and Associate Professor of Pathology, Harvard Medical School, Boston, Massachusetts.

JAMA. 2011;306(17):1902-1910. doi:10.1001/jama.2011.1526
Abstract

Globally, more than 81 million units of red blood cells are transfused annually. Of the 15 million red blood cell components transfused annually in the United States, approximately 40% are transfused to patients undergoing elective surgical procedures. Because of concerns about limited blood availability as well as risks of transfusion-related adverse events, blood products should be used judiciously. Using the case of Ms C, a 68-year-old woman considering autologous blood donation prior to knee replacement surgery, the concept of patient blood management is discussed. This approach entails a complete evaluation of the patient in the preoperative period to assess for bleeding risks and anemia, with a goal to optimize a patient's condition prior to surgery; use of various strategies in the operative period to mitigate the need for allogeneic blood transfusion; and meticulous postoperative care to again avoid the need for blood transfusion.

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