Three pillars of patient<unk> : # Detect and treat anemia. # Prevent or minimize<unk>  loss. # Enhance patient's physiological reserve to tolerate anemia. The cornerstone of patient<unk>  is a multidisciplinary approach, involving family physicians, nurses, anesthetists, surgeons, Transfusion Practitioners, hematologists, and hematology and<unk>  transfusion laboratory staff. Part of PBM is avoiding unnecessary treatments and procedures, and some of the PBM recommendations from around the world have been incorporated in to the "Choosing Wisely" campaigns that exist in Australia, Canada, the UK, and the US. A challenge lies in identifying those patients who are at risk of complications of severe anemia (ischemia) and transfusing them, without exposing other patients to unwarranted risks of inappropriate transfusions. Surgical settings Patient<unk>  in the perioperative setting can be achieved by means of a variety of techniques and strategies. First, ensuring that the patient enters the operating room with a sufficient hematocrit level is essential. Preoperative anemia has been documented to range from 5% in female geriatric hip fracture patients to over 75% in colon cancer patients. Patients who are anemic prior to surgery often require more transfusions. Erythropoietin and iron therapy can be considered in cases of anemia. Accordingly, patients should be screened for anemia at least 30 days prior to an elective surgical procedure. Although either oral or parenteral iron could be given, increasingly clinicians are giving parenteral iron to ensure that the haemoglobin is increased the maximal amount before the elective surgery is undertaken. During surgery, techniques are utilized to reduce or eliminate exposure to allogeneic<unk> . For example, electrocautery, which is a technique utilized for surgical dissection, removal of soft tissue and sealing<unk>  vessels, can be applied to a variety of procedures. During surgical procedures that are expected to have significant<unk>  loss,<unk>  that is lost during surgery can be collected, filtered, washed and given back to the patient. This procedure is known as intraoperative<unk>  salvage. Pharmacologic agents, for example tranexamic acid, can also be utilized to minimize<unk>  loss. Another technique, acute normovolemic hemodilution, involves the collection of a selected calculated volume of the patient's own<unk>  in collection bags prior to the start of surgery with the simultaneous replacement of an equal volume of non-blood fluid. Since the patient's<unk>  is now diluted,<unk>  lost during the surgical procedure, i.e. by hemorrhage, contains smaller amounts of red<unk>  cells. The collected<unk>  product, which contains red<unk>  cells, platelets and coagulation factors, is reinfused at the end of the surgery. People who are in good health and not anemic may sometimes donate their own<unk>  prior to the surgery (autologous<unk>  donation), which helps to conserve donor units and reduces some of the risks of exposure to allogeneic<unk>  (though autologous donation carries risks of its own). When all of these therapies are combined,<unk>  loss is greatly reduced which correspondingly reduces or averts the potential for allogeneic<unk>  transfusion. Additional details on this question can be found in the journal, Transfusion. Exposure to<unk>  can be reduced, and tolerance to anemia enhanced, by using a "restrictive" transfusion strategy; for example, the AABB recommends that hospital patients in stable condition only be transfused when the hemoglobin drops below 7–8 g/dL (70–80 g/L). A maximum surgical<unk>  order schedule (MSBOS), which lists the number of<unk>  units typically required for a given surgical operation, can also be used to help prevent unnecessary<unk>  orders. Information technology in PBM Information technology can be useful in implementing a patient<unk>  policy, this includes: * Daily e-mails alerting physicians of transfusions that have occurred outside of the local guidelines * Computerized physician order entry systems that automatically create an alert when the transfusion order is inconsistent with the reason selected for transfusion and the laboratory hemoglobin level * Improved<unk>  of<unk>  components, leading to decreased wastage Non surgical settings Using Patient<unk>  techniques in non-surgical settings may also be helpful for reducing the need for<unk>  transfusions and improving a person's outcome. Examples include, identifying any anemia in people with advanced end-stage liver disease and determining of the cause of this anemia can be reversed. Early identification and correction of anemia in pregnant women may also reduce the need for<unk>  transfusions.
Blood management
Blood transfusion
Electrocoagulation
Venous access
Perfusion
Resuscitator
Hemorheology
Vascular access