General Perioperative Measures and Management
Anaemia Cell salvage Anaemia Consensus Grade 3.1 Patients who are anaemic (Hb <13g/dL) should be investigated and the cause treated appropriately. Yes A 3.2 Patient pathways and pre-assessment clinics should be established to allow timely and appropriate management, and elective surgery should be delayed if required. Yes B Preoperative anaemia is common and is associated with worse outc
Anaemia
| Consensus | Grade | ||
| 3.1 | Patients who are anaemic (Hb <13g/dL) should be investigated and the cause treated appropriately. | Yes | A |
| 3.2 | Patient pathways and pre-assessment clinics should be established to allow timely and appropriate management, and elective surgery should be delayed if required. | Yes | B |
Preoperative anaemia is common and is associated with worse outcomes. It occurs in up to a third of patients before surgery (and in as many as 50% of patients at government hospitals in South Africa). All patients should have their Hb checked before listing for surgery. Patients who are anaemic (Hb <13g/dL) should be investigated and the cause treated appropriately.9,12,13 Patient pathways and pre-assessment clinics should be established to allow timely and appropriate management, and elective surgery should be delayed if more time is required for the Hb to increase.14 If anaemia clinics are not possible, then all patients should be screened preoperatively at their respective outpatient departments or clinics, with subsequent appropriate therapy for the anaemia. Whenever possible, the objective should be to operate on patients who are not anaemic (in particular, elective procedures).
Cell Salvage
| Consensus | Grade | ||
| 4.1 | The use of cell salvage should be considered for high- or medium-risk surgery in non-obstetric adult patients where blood loss >500ml is likely. | Yes | B |
| 4.2 | The use of cell salvage should be considered for obstetric major haemorrhage. | Yes | B |
| 4.3 | In patients with malignancy or obstetric haemorrhage, a leucocyte filter must be used. | Yes | C |
| 4.4 | Bacterial contamination of the surgical field remains a relative contraindication. Use of a leucocyte filter is advised. | Yes | C |
| 4.5 | Cell salvage may also be continued in the postoperative period. | Yes | B |
Cell salvage represents a key strategy in reducing exposure to allogeneic blood transfusion and preserving donor blood. International guidelines are applicable to the South African context,15 and recommend that cell salvage should be used when it will reduce the likelihood of blood transfusion or severe postoperative anaemia. It should ideally be available after-hours, necessitating appropriate staff training and availability of equipment. The use of cell salvage should be considered for high- or medium-risk surgery in non-obstetric adult patients where blood loss >500ml is likely, and in major obstetric haemorrhage. Blood should be collected from the start of surgery, but the decision to process blood can be based on the volume collected, to minimise the risk of opening expensive processing sets that are not used. In patients with malignancy or obstetric haemorrhage, a leucocyte filter must be used. Bacterial contamination of the surgical field remains a relative contraindication, and should also be given through a leucocyte filter if transfused. Cell salvage may also be continued in the postoperative period.16
South African Society of Anaesthesiologists (SASA) Guidelines for Patient Blood Management 2020. Confirmed as current version on the SASA website as of November 2024.