Transfusion Medicine and Blood Management During Cardiac Surgery

Cardiac surgery patients frequently require perioperative blood transfusions due to significant comorbidities, the higher risk of hemorrhage with these surgeries, and the potential loss of functional blood components from undergoing cardiopulmonary bypass (CPB). Understanding transfusion medicine and blood management are therefore necessary parts of caring for these patients. The types of interventions can be separated into preoperative, intraoperative, and postoperative strategies. Preoperative management starts with patient optimization, including the identification of individuals who are at higher risk of requiring perioperative blood transfusions. This is followed by the treatment of pre-existing anemia and the discontinuation of antiplatelets and/or anticoagulants to aid in minimizing blood loss during surgery. Intraoperative management consists of blood conservation strategies and the use of hemostasis testing to guide transfusions of specific blood products for patient-dependent deficiencies. Finally, in the immediate postoperative period, laboratory studies are followed to continue adequate resuscitation prompted by specific triggers and patient needs.