Shah Akshay, Klein Andrew A, Agarwal Seema, Lindley Andrew, Ahmed Aamer, Dowling Kerry, Jackson Emma, Das Sumit, Raviraj Divya, Collis Rachel, Sharrock Anna, Stanworth Simon J, Moor Paul
Nuffield Department of Clinical Neurosciences and NIHR Blood and Transplant Research Unit in Data Driven Transfusion Practice, University of Oxford, Oxford, UK.
Department of Anaesthesia, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Anaesthesia. 2025 Apr;80(4):425-447. doi: 10.1111/anae.16542. Epub 2025 Jan 9.
The administration of blood components and their alternatives can be lifesaving. Anaemia, bleeding and transfusion are all associated with poor peri-operative outcomes. Considerable changes in the approaches to optimal use of blood components and their alternatives, driven by the findings of large randomised controlled trials and improved haemovigilance, have become apparent over the past decade. The aim of these updated guidelines is to provide an evidence-based set of recommendations so that anaesthetists and peri-operative physicians might provide high-quality care.
An expert multidisciplinary, multi-society working party conducted targeted literature reviews, followed by a three-round Delphi process to produce these guidelines.
We agreed on 12 key recommendations. Overall, these highlight the importance of organisational factors for safe transfusion and timely provision of blood components; the need for protocols that are targeted to different clinical contexts of major bleeding; and strategies to avoid the need for transfusion, minimise bleeding and manage anticoagulant therapy.
All anaesthetists involved in the care of patients at risk of major bleeding and peri-operative transfusion should be aware of the treatment options and approaches that are available to them. These contemporary guidelines aim to provide recommendations across a range of clinical situations.
血液成分及其替代品的输注可挽救生命。贫血、出血和输血均与围手术期不良结局相关。在过去十年中，受大型随机对照试验结果和改进的血液监测的推动，血液成分及其替代品的最佳使用方法发生了显著变化。这些更新指南的目的是提供一套基于证据的建议，以便麻醉医生和围手术期医生能够提供高质量的护理。
一个多学科、多学会的专家工作小组进行了有针对性的文献综述，随后经过三轮德尔菲法制定了这些指南。
我们达成了12项关键建议。总体而言，这些建议强调了组织因素对安全输血和及时提供血液成分的重要性；针对不同大出血临床情况制定方案的必要性；以及避免输血需求、减少出血和管理抗凝治疗的策略。
所有参与照顾有大出血风险和围手术期输血风险患者的麻醉医生都应了解他们可采用的治疗选择和方法。这些当代指南旨在针对一系列临床情况提供建议。
