Pre-Amber alert: Blood shortages

There are escalating concerns about blood stocks, in particular O-negative. In light of this, we would direct members' attention to the CPOC Guideline for the Management of Anaemia in the Perioperative Pathway published in 2022.

Other resources may also be useful:

• BMJ article about the perioperative use of tranexamic acid led by Professor Ian Roberts

For preoperative assessment teams / perioperative physicians

1. Identify patients who are at risk of anaemia as early as possible in preoperative elective pathways. Treat anaemia with iron, B12 and/or Folate as required

For surgeons and ward teams in general

1. Minimise iatrogenic anaemia, take samples from patients only if this will change clinical management
2. Where possible, use a restrictive red cell transfusion threshold, haemoglobin of 70 g/L unless patient is bleeding, has acute coronary syndrome, or is on a chronic transfusion programme
3. Where possible transfuse one unit
4. Send G&S on bleeding patients and switch to group specific as soon as possible

For anaesthetists / theatre teams

1. Consider tranexamic acid in all patients having major surgery 
2. Administer if risk of perioperative blood loss likely to be >500ml
3. Where possible and required, transfuse one unit only before reassessing