Purpose: To formulate a plan to minimize the need for allogeneic blood transfusion in a patient undergoing elective surgery.			Citations with documentation. 05.01.12	Medal Project 2002. See disclaimer.
conversion	enter
body weight in pounds		lbs equals	0	kilograms
data	enter
Are you evaluating a patient prior to elective surgery? (Y or N)		:-):-):-)
gender of the patient (enter M or F)		:-):-):-)
lean body weight in kilograms		kilograms
Is there evidence before surgery of iron deficiency or megaloblastic anemia? (Y or N)		:-):-):-)
Is the patient taking aspirin or other antiplatelet agent? (Y or N)		:-):-):-)
Is the patient is receiving anticoagulants? (Y or N)		:-):-):-)
Is equipment for intra-operative red blood cell salvage available? (Y or N)		:-):-):-)
calculate	result
data complete?	Yes
evaluation appropriate?	Yes	:-):-):-)
rough estimate of blood volume	4,752	mL
Preoperative Plan:
• Perform screening laboratory tests (CBC, PT, PTT, chemical panel).
• Collect a specimen for blood bank testing (Type and Hold, Type and Screen or Type and Crossmatch)
• Treat with iron, folate or vitamin B12 as needed.
• Identify bleeding tendency based on history, dental extractions and previous surgical procedures.
• Consider autologous blood collection.
• Consider erythropoietin to increase red blood cell production.
• Discontinue antiplatelet agents sufficient to reduce effect by day of surgery.
• Adjust anticoagulation so that it can be reversed prior to surgery.
Perioperative Plan:
• Consider acute normovolemic hemodilution.
• Consider intra-operative blood salvage if the surgical procedure permits.
• Consider hypotensive surgery if appropriate.
• Warm all fluids to avoid hypothermia.
• Maintain meticulous hemostasis.
Postoperative Plan:
• Transfuse only if necessary, using the minimum number of units.
• Administer supplemental oxygen.
• Prescribe iron, folate and vitamin B12.