PATIENT BLOOD MANAGEMENT AT YRMC

Strategies to Minimize Blood Loss and Enhance Blood Production

Detect, prevent and respond to hemorrhage and anemia at the outset of treatment. Anemia is a manifestation of underlying disease and should be treated preoperatively, if possible.

Appropriate Diagnostic Testing for all Patients

• Minimize blood draw volumes
• Combine tests to reduce the frequency of blood draws
• Monitor and manage routine orders for blood tests

Preoperative Blood Management Strategies—Optimize Red Blood Cell Mass
The following medications, agents and management will be considered for anemic patients:

• Iron therapy
• Judicious use of Erythropoiesis stimulating agents (ESA)
• Vitamins B6, B12, K and Folic Acid
• Nutritional support
• Manage medications that affect coagulation
• Consider delaying surgery until better blood scores are achieved

Intraoperative Blood Management Strategies—Close Surveillance for Blood Loss and Prompt Arrest of Bleeding

• Perioperative use of acute normovolemic hemodilution—removal of a calculated amount of blood prior to surgery, replace with non-blood expanders with reinfusion of red cells back to patient
• Intraoperative blood salvage—the process of collecting the patient’s blood lost during surgery and washing, filtering and reinfusion of red blood cells back to the patient
• Judicious volume resuscitation such as by crystalloids and colloids
• Hemostatic agents—oral, parenteral and topical
• Meticulous surgical techniques

Postoperative Blood Management Strategies

• Minimize blood draw frequency and volume
• Postoperative blood salvage—the process of collecting the patient’s blood lost after surgery and washing, filtering and reinfusion of red blood cells back to the patient
• Continued Iron therapy
• Judicious use of Erythropoiesis stimulating agents (ESA)
• Nutritional support
• Low tolerance for re-exploration if post-operative bleeding is excessive

For more information about Patient Blood Management at YRMC, please call Dale Black, Program Coordinator, at (928) 771-5109.