Evidence
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- 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).
- Li C, Gong Y, Dong L, Xie B, Dai Z. Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention? A systematic review and meta-analysis. Medicine. 2017;96(-1):e5653-e.
- Ray S, Ray A. Non-surgical interventions for treating heavy menstrual bleeding (menorrhagia) in women with bleeding disorders. The Cochrane Database of Systematic Reviews. 2016(-11):CD010338-CD.
- Prutsky G, Domecq JP, Salazar CA, Accinelli R. Antifibrinolytic therapy to reduce haemoptysis from any cause. The Cochrane Database of Systematic Reviews. 2016(-11):CD008711-CD.
- Jiang M, Chen P, Gao Q. Systematic review and network meta-analysis of upper gastrointestinal hemorrhage interventions. Cellular Physiology and Biochemistry : International Journal of Experimental Cellular Physiology, Biochemistry, and Pharmacology. 2016;39(-6):2477-91.
- Roberts I, Shakur H, Ker K, Coats T, collaborators C-T. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database of Systematic Reviews. 2015;5:CD004896-CD.
- Marti-Carvajal AJ, Sola I. Antifibrinolytic amino acids for upper gastrointestinal bleeding in people with acute or chronic liver disease. Cochrane Database of Systematic Reviews. 2015(-6):CD006007-CD.
- Alam A, Choi S. Prophylactic use of tranexamic acid for postpartum bleeding outcomes: a systematic review and meta-analysis of randomized controlled trials. Transfusion Medicine Reviews. 2015;29(-4):231-41.
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