Patient blood management and its importance for primary care physicians

For patients undergoing elective surgery, patient blood management is multimodal, multidisciplinary, patient-centric care that aims to improve patient outcomes by minimizing the unnecessary use of allogeneic blood transfusions.1 Patient blood management preserves the allogeneic blood resource and is achieved by addressing anaemia, blood loss and hypoxia as modifiable risk factors for blood transfusion, long before transfusion would even be considered.2

If a hospital employs a patient blood management program, it is likely that patients scheduled for elective surgery will have their preoperative hemoglobin and iron status assessed approximately 4 weeks before surgery.1 Since preoperative anaemia is associated with a number of adverse postoperative outcomes, such as an increased risk of allogeneic blood transfusion,3 morbidity,1 and mortality,1 efforts should be made to rectify anaemia in the patient prior to surgery.1 Primary care physicians may be contacted at this stage in order to initiate treatment of the patient’s anaemia.4

Primary care physicians can also play an important role in postoperative patient blood management, since they may be responsible for the patient’s postoperative follow-up. For optimal patient blood management after surgery it is important that:5

  • Erythropoiesis is optimised
  • Awareness is maintained for drug interactions that may cause or exacerbate anaemia
  • Infections are monitored for and treated promptly

For more information about optimizing patient blood management see ‘Avoiding transfusions in elective surgery’

Treating iron deficiency before and after surgery

Although there are multiple possible causes of anaemia, iron deficiency has been shown to be the predominant cause in preoperative elective surgery patients.3

If iron therapy is required to rectify iron deficiency, iron can be given as an oral iron supplement6 or as intravenous iron.7 Preoperatively, the choice between oral and intravenous iron may depend on the duration of time before surgery is scheduled to occur.4