Operational alternatives

• Treatment of preoperative anaemia with haematinics, if appropriate, in a timely way at preassessment clinics.

• Autologous transfusion in all its forms. It seems that cell salvage is considerably more cost-effective than pre-deposit auto-logous transfusion. The value of preoperative haemodilution needs further assessment.

• Re-evaluation of transfusion triggers and algorithms for estimation of acceptable blood loss in surgery. Adherence to guidelines.

• Alternative fluid replacement (i.e. replace FFP with crystalloids or colloids when appropriate).

• Anaesthetic methods to reduce blood loss (e.g. hypotension).

• Enhancement of surgical haemostasis and new surgical technologies (e.g. water scalpels).

• Stopping aspirin, non-steroidal anti-inflammatory drugs (NSAIDS) and anticoagulants preoperatively.

• Post-operative haematinics.

• Near-patient testing in theatre.

• Miniaturizing blood sampling in intensive care units for premature babies and adults.

• Stem cell transplantation for transfusion-dependent patients (e.g. thalassaemia).

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