Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery

Warwick Bruce, David Campbell, David Daly, J Isbister

    Research output: Contribution to journalReview articlepeer-review

    26 Citations (Scopus)


    Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients' medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients.

    Original languageEnglish
    Pages (from-to)222-229
    Number of pages8
    JournalANZ Journal of Surgery
    Issue number4
    Publication statusPublished - Apr 2013


    • Anaemia
    • Antifibrinolytic agent
    • Arthroplasty
    • Blood transfusion
    • Joint replacement surgery
    • Normothermia
    • Patient blood management


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