- NICE Guideline Recommendations 1-5: Alternatives to blood transfusion for patients having surgery: Oral iron, IV iron and erythropoietin
- Do not offer erythropoietin to reduce the need for blood transfusion in patients having surgery, unless:
- the patient has anaemia and meets the criteria for blood transfusion, but declines it because of religious beliefs or other reasons or
- the appropriate blood type is not available because of the patient’s red cell antibodies.
- Offer oral iron before and after surgery to patients with iron-deficiency anaemia.
- Consider intravenous iron before or after surgery for patients who:
- have iron-deficiency anaemia and cannot tolerate or absorb oral iron, or are unable to adhere to oral iron treatment (see the NICE guideline on medicines adherence)
- are diagnosed with functional iron deficiency
- are diagnosed with iron-deficiency anaemia, and the interval between the diagnosis of anaemia and surgery is predicted to be too short for oral iron to be effective.
- For guidance on managing anaemia in patients with chronic kidney disease, see the NICE guideline on anaemia management in chronic kidney disease.
- For guidance on managing blood transfusions for people with acute upper gastrointestinal bleeding, see section 1.2 in the NICE guideline on acute upper gastrointestinal bleeding.
- NICE Guideline Recommendations 6-9: Alternatives to blood transfusion for patients having surgery: Cell salvage and tranexamic acid
- 6. Offer tranexamic acid to adults undergoing surgery who are expected to have at least moderate blood loss (greater than 500 ml)
- 7. Consider tranexamic acid for children undergoing surgery who are expected to have at least moderate blood loss (greater than 10% blood volume).
- 8. Do not routinely use cell salvage without tranexamic acid.
- 9. Consider intra-operative cell salvage with tranexamic acid for patients who are expected to lose a very high volume of blood (for example in cardiac and complex vascular surgery, major obstetric procedures, and pelvic reconstruction and scoliosis surgery).
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