The perioperative Patient Blood Management (in Hungary National Blood Donation and
Blood Saving Program) is an individualized clinical practice based on a multidisciplinary
consensus with a comprehensive and complex approach. It supports the rational and
judicious utilization of blood products and abolishes irrational transfusion policy.
Its practical implementation is based upon three pillars: 1. anemia management without
transfusion, if possible; restrictive transfusion strategy; 2. minimization of blood
loss; 3. enhancement of anemia tolerance. Early detection, clarification of etiology
and appropriate treatment are the most important tools for the management of preoperative
anemia before surgeries with a high risk of bleeding. Minimization of blood loss can
be achieved by identifying patients with congenital or acquired bleeding disorders,
preparing them appropriately for surgery, discontinuing anticoagulants and antiplatelet
drugs for a sufficient time in the preoperative phase of surgery and reversing their
effects to comply with current guidelines. Minimal-invasive approaches are preferable.
Intraoperatively, atraumatic technique and accurate topical haemostasis should be
provided by surgeons. Autologous blood salvage techniques and controlled hypotension
in lack of contraindications can also reduce the amount of blood loss. In cases of
perioperative bleeding, protocols based on international guidelines but adapted to
local circumstances must be used. Ideally, it should be managed by viscoelastic test-guided,
goal-directed, individualized and factor concentrate-based algorithm. Perioperatively,
an ideal oxygen demand/supply ratio must be ensured to avoid oxygen debt. Restoration
and maintenance of homeostasis are essential for both the effectively functioning
haemostatic system and the avoidance of oxygen deficit. Implementation of the Patient
Blood Management improves patient safety, reduces the cost of medical care and facilitates
the national blood product supply. Its successful introduction is our common interest.
