South African Society of Anaesthesiologists Perioperative Patient Blood Management Guidelines 2020

Abstract

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.

Use of Dried Plasma in Prehospital and Austere Environments

“…Where available, lyophilized CLINICAL FOCUS REVIEW plasma is considered interchangeable with FFP. 13,14,34,54,55,59 Lyophilized plasma is generally preferred when logistical issues are important, such as in austere environments or rural settings, or when speed of use/availability is an important factor, such as traumatic hemorrhage, perioperative hemorrhage, postpartum hemorrhage, or substantial gastrointestinal bleeding. Cold-chain requirements are challenging for humanitarian or military operations, and FFP bag breakage can be significant.…”

“…15 Consensus guidelines for blood management in South Africa state that the product is used interchangeably with FFP in all types of patients, including those with significant blood loss, such as may result from trauma or postpartum bleeding. 54,55 In some locations in South Africa, such as KwaZulu-Natal (especially at rural hospitals), Bioplasma FDP is the primary plasma used. The safety and efficacy of Bioplasma FDP (n = 23) was compared to fresh dried plasma (n = 20; without pathogen reduction) in a prospective single-blinded trial in patients undergoing cardiopulmonary bypass.…”

Recent advances in perioperative blood management

“…[ 11 ] The threshold, targets, indications and dose of various blood components are variable [ Table 2 ]. [ 11 , 12 ]…”

Anaesthesia for ruptured ectopic pregnancy at district level

“…Clinicians should be aware of local perioperative blood management guidelines. 12 District hospitals should have stock of emergency blood on-site. In case of limited availability of blood, we suggest that this blood should be used pre-induction if the haemoglobin (Hb) is < 5 g/dL; be in theatre if the Hb is < 7 g/dL and be available from the fridge on short notice if the Hb is > 7 g/dL.…”