Introduction: Perioperative Patient Blood Management
Anaesthesiologists regularly request and administer blood components to their patients, a potentially life-saving intervention. All anaesthesiologists must be familiar with the indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematologists and their local haematology blood sciences laboratory is encouraged. In the last decade, there hav
Anaesthesiologists regularly request and administer blood components to their patients, a potentially life-saving intervention. All anaesthesiologists must be familiar with the indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematologists and their local haematology blood sciences laboratory is encouraged. In the last decade, there have been considerable changes in approaches to optimal use of blood components, together with the use of alternative products, with a need to update previous guidelines and adapt them for anaesthesiologists working throughout the hospital system.
The SASA Patient Blood Management (PBM) Guidelines have been developed to improve perioperative PBM in South Africa. These recommendations have been compiled through a thorough and meticulous process by a group of experts working in the field in South Africa. The process started in 2018 and comprised a Delphi technique, collation and review of the latest and relevant medical literature, and a consensus meeting that took place at the SASA National Congress (Port Elizabeth, March 2019).
The guidelines focus on the broader principles of PBM, incorporating transfusion medicine (transfusion guidelines), management of anaemia, optimisation of coagulopathy, and administrative and ethical considerations.
There is a mix of low-middle income and high-income healthcare structures within South Africa. However, blood products are provided by the same not-for-profit non-governmental organisations to both private and public sectors. This environment faces several challenges related to PBM, most notably a high prevalence of anaemia (as much as 50% in preoperative patients in South African government hospitals) and iron deficiency, a frequent shortage of blood products, a small donor population, and a healthcare system under financial strain.1,2 The rational and equitable use of blood products is essential to help ensure optimal care for as many perioperative patients as possible.
The summary of the recommendations provides key practice points for the day-to-day management of perioperative patients. A more detailed description of the evidence used to make these recommendations follows in the full clinical guidelines section.
Acknowledgement and thanks to the organisers of the SASA Congress 2019, all the authors who participated, and the support of the SASA. Particular thanks are extended to the Association of Anaesthetists of Great Britain and Ireland (AAGBI) for their support and access to the AAGBI Use of Blood Components and Their Alternatives (2016), and the Task Force on Patient Blood Management for Adult Cardiac Surgery of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardiothoracic Anaesthesiology (EACTA).
South African Society of Anaesthesiologists Perioperative Patient Blood Management Guidelines 2020. Confirmed as current version on the SASA website as of November 2024.