- Screen, diagnose and treat appropriately all anemia including prior to surgery, allowing adequate lead time to correct the anemia.
- Establish a system to address anemia both for outpatient and inpatient
- Prompt identification of anemia during and after surgery using all available techniques.
- Establish single unit transfusion policy.
- Implement mercuriali-algorithm to calculate RBC deficit.
- Consider alternative therapies to RBC transfusions
- Intravenous iron.
- Erythropoietin stimulating agents (ESAs).
- Introduce a protocol for RBC transfusion decision-making.
- Normovolemia should be checked before restrictive transfusion.
- Advocate restrictive transfusion practices.
- Develop guidelines locally that reduce patients’ exposure to allogeneic transfusions including lower hemoglobin triggers for transfusion.
- Introduce proactive review instead of the commonly used retroactive review.
- Consideration of not just hemoglobin levels but also the change in hemoglobin levels from baseline, as an indicator or need for transfusion.37
- Transfusion decision making based on signs and symptoms, in addition to hemoglobin level - consider symptoms including chest pain, orthostatic hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure \cite{Carson_2012}.
- Benchmarking of hemotherapy product use by individual units and/or hospitals may be a significant tool in change management and implementation of Patient Blood Management.
- Documentation of hemoglobin before the transfusion of each RBC unit.21
- Utilize hemoglobin monitoring technologies to augment laboratory testing to obtain additional information about patient status before transfusion decisions are made.