Table 1 Blood sparing strategies in emergency setting

Preoperative

Detect and manage anemia

Identify and manage underlying bleeding diathesis and bleeding risk

Refer for further evaluation if necessary

Apply Massive transfusion protocols

Apply risk scores

Intraoperative

Meticulous hemostasis and surgical techniques

Blood-sparing surgical devices

Anesthetic blood-conserving strategies

Autologous blood options

Maintain normothermia

Pharmacological/hemostatic agents

Viscoelastic test

Optimize cardiac output

Optimize ventilation and oxygenation

Optimize patient position

Postoperative

Optimize erythropoiesis

Be aware of drug interactions that can increase anemia

Vigilant monitoring and management of postoperative bleeding

Avoid secondary hemorrhage

Rapid warming, maintain normothermia (unless hypothermia specifically indicated)

Minimize iatrogenic blood loss

Hemostasis/anticoagulation management

Prophylaxis of upper GI hemorrhage

Avoid/treat infections promptly

Optimize anemia reserve

Maximize oxygen delivery

Minimize oxygen consumption

Restrictive transfusion thresholds