Korean clinical practice guideline for perioperative red blood cell transfusion from Korean Society of Anesthesiologists

Abstract

Background Considering the functional role of red blood cells (RBC) in maintaining oxygen supply to tissues, RBC transfusion can be a life-saving intervention in situations of severe bleeding or anemia. RBC transfusion is often inevitable to address intraoperative massive bleeding; it is a key component in safe perioperative patient management. Unlike general medical resources, packed RBCs (pRBCs) have limited availability because their supply relies entirely on voluntary donations. Additionally, excessive utilization of pRBCs may aggravate prognosis or increase the risk of developing infectious diseases. Appropriate perioperative RBC transfusion is, therefore, crucial for the management of patient safety and medical resource conservation. These concerns motivated us to develop the present clinical practice guideline for evidence-based efficient and safe perioperative RBC transfusion management considering the current clinical landscape. Methods This guideline was obtained after the revision and refinement of exemplary clinical practice guidelines developed in advanced countries. This was followed by rigorous evidence-based reassessment considering the healthcare environment of the country. Results This guideline covers all important aspects of perioperative RBC transfusion, such as preoperative anemia management, appropriate RBC storage period, and leukoreduction (removal of white blood cells using filters), reversal of perioperative bleeding tendency, strategies for perioperative RBC transfusion, appropriate blood management protocols, efforts to reduce blood transfusion requirements, and patient monitoring during a perioperative transfusion. Conclusions This guideline will aid decisions related to RBC transfusion in healthcare settings and minimize patient risk associated with unnecessary pRBC transfusion.

Viscoelastic coagulation test for liver transplantation

“…For this reason, the application of viscoelastic coagulation test for liver transplantation can reduce bleeding and blood transfusion. Therefore, the Korean guideline for perioperative blood transfusion [ 28 ] and the guideline by the American Society of Anesthesiologists [ 29 ] consider the blood transfusion strategies using TEG and ROTEM to be important for not only liver transplantation but also perioperative blood management. Moreover, the guidelines for management of severe perioperative bleeding published by the European Society of Anaesthesiology [ 30 ] state that CCT is not suitable for surgeries in patients with liver disease and recommend TEG or ROTEM to diagnose perioperative coagulation disorders.…”

A randomised trial evaluating the effect of intraoperative iron administration

“…Iron deficiency, secondary to intraoperative blood loss and increased iron requirements, is the leading cause of anaemia in surgical patients 3,4 . Identification of preoperative anaemia and iron deficiency has been recommended for all those with anticipated moderate to high (> 500 mL) surgical blood loss 5,6 .…”

<p>Peripartum Blood Transfusions are Associated with Increased Risk of Cancer: A National Retrospective Cohort Study</p>

“…Factors that may influence the immunomodulatory effect of transfusions, including storage time 37 and use of leukocyte-reduced blood, 38 were not obtained. We note that South Korea does not mandate leukocyte depletion, 39 and in fact, one study found that only 10.3% of blood products in South Korea were leukocyte reduced in 2009. 40 The recency of our data had the disadvantage of limiting the possible follow-up period to 8 years, and any longer-term effects of transfusions were unable to be evaluated.…”