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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

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.