Perioperative blood management

Perioperative blood management has evolved in recent years, and new approaches to blood conservation and replacement have dramatically changed the treatment of surgical patients. This article addresses the historical continuum of blood transfusions and describes current standards of practice in perioperative blood management in orthopaedic patients. Certain elective orthopaedic procedures lend themselves well to preoperative planning for blood loss. Since total joint arthroplasty can be associated with large volume blood loss, planning to replace lost blood is mandatory. Allogeneic, designated (or directed) donor, and autologous blood transfusion have been the standard of practice for blood replacement until very recently. Epoetin alfa, an FDA-approved treatment for anemia, can be administered perioperatively to total joint arthroplasty patients to help prevent the necessity of postoperative transfusion. Inspired by the infection risk associated with allogeneic blood transfusion, this development represents a growing trend in perioperative blood management of the orthopaedic patient.