Patient blood management and surgery: Impact of new surgical techniques on transfusion needs

Patient blood management (PBM) is a multidisciplinary approach aimed at reducing the use of blood products. It considers the patient's own blood as a valuable resource to preserve and seeks to avoid the routine use of transfusions to treat anaemia. PBM is primarily based on interventions implemented by anaesthesiologists, including preoperative anaemia correction, targeted administration of coagulation factors and tranexamic acid and strict adherence to transfusion protocols. However, the role of surgical approaches in this context deserves attention. Indeed, surgical innovations over the past two decades have significantly contributed to reducing transfusion requirements. This review will focus on this aspect of PBM.

For this review, we performed a comprehensive search of the PubMed database related to PBM in surgery and also consulted other relevant databases.

In the preoperative period, advances in diagnostic techniques, surgical indications and surgical access allow for two blood-sparing options: active surveillance or alternatives to surgery. In the intraoperative period, the development of minimally invasive approaches, the use of innovative haemostatic techniques, per surgery autologous transfusion (cell salvage) and the prevention of hypothermia contribute to the reduction of blood loss and, consequently, the need for transfusion. In the postoperative period, proactive patient management through careful monitoring and the application of enhanced recovery after surgery principles plays a major role in decreasing overall postoperative morbidity.

These innovations have significantly reduced the need for transfusion in surgical practice. They enhance patient safety by minimizing bleeding and transfusion-related risks.