Practical Guidelines for Evaluating Transfusion Needs

Abstract

It is estimated that ∼24 million units of blood products are administered annually in the United States, with ∼10% of all packed red blood cell transfusions used in orthopedic surgery. Protocols and guidelines for the administration of blood vary widely among orthopedic practices and hospitals. Although transfusions can be lifesaving, their use carries substantial risks, from minor to life-threatening complications. Therefore, transfusions should be considered a last option when dealing with postoperative anemia. Blood conservation and taking steps to avoid postoperative anemia should be goals in orthopedic surgery. Creating a standardized approach to blood management is important to enhance outcomes and decrease transfusions and their attendant risks. This includes correcting preoperative anemia when possible and using techniques to minimize perioperative blood loss. Restrictive transfusion triggers have been shown to decrease the number of transfusions without compromising outcomes. Use of antifibrinolytic agents such as tranexamic acid has also decreased the need for transfusions. This article reviews current transfusion practices, including indications and contraindications, perioperative blood management techniques, transfusion complications, and safe transfusion thresholds for patients undergoing orthopedic surgery.