Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Clinical and Laboratory Assessment of the Patient

Silva, Roberto Luiz da; Benites, Bruno Deltreggia; Leite, Flavia; Soriano, Selma; Alves, Susankerle de Oliveira Costa; Rizzo, Silvia Renata Cornélio Parolin; Rabello, Guilherme; Langhi Junior, Dante Mario

doi:10.1016/j.htct.2024.02.007

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Hematology, Transfusion and Cell Therapy

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Special article • Hematol., Transfus. Cell Ther. 46 (suppl 1) • 2024 • https://doi.org/10.1016/j.htct.2024.02.007 copy

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Clinical and Laboratory Assessment of the Patient

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.

Keywords
Blood conservation; Surgical bleeding; Rational use of blood patient blood management

complexity of the surgery	Laboratory examinations	ASA I	ASA II	ASA III
Minor	Complete blood count	Do not request routinely	Do not request routinely	Do not request routinely
	Coagulogram	Do not request routinely	Do not request routinely	Do not request routinely
	Renal function	Do not request routinely	Do not request routinely	Request if at risk for AKI
Medium	Complete blood count	Do not request routinely	Do not request routinely	Request if heart or kidney disease
	Coagulogram	If uses anticoagulant^* ⁎ Request exam and plan depending on the anticoagulant. Performing prothrombin time (TP) and activated partial thromboplastin time (aTPP) tests are not recommended routinely, as they do not estimate the risk of bleeding in the absence of clinical history of hemorrhagic manifestations.	If uses anticoagulant^* ⁎ Request exam and plan depending on the anticoagulant. Performing prothrombin time (TP) and activated partial thromboplastin time (aTPP) tests are not recommended routinely, as they do not estimate the risk of bleeding in the absence of clinical history of hemorrhagic manifestations.	If uses anticoagulant^* ⁎ Request exam and plan depending on the anticoagulant. Performing prothrombin time (TP) and activated partial thromboplastin time (aTPP) tests are not recommended routinely, as they do not estimate the risk of bleeding in the absence of clinical history of hemorrhagic manifestations. or has liver disease
	Renal function	Do not request routinely	Do not request routinely	Yes
Major complex	Complete blood count	Yes	Yes	Yes
	Investigation of iron/Vitamin B12/Folic acid^⁎⁎ ⁎⁎ For all patients that will be submitted to major surgery and for any patient with signs/symptoms of anemia or with risk factors for anemia/iron or vitamin deficiency. Adapted from Excellence and People (2008).2	Yes	Yes	Yes
	Coagulogram	If uses anticoagulant^* ⁎ Request exam and plan depending on the anticoagulant. Performing prothrombin time (TP) and activated partial thromboplastin time (aTPP) tests are not recommended routinely, as they do not estimate the risk of bleeding in the absence of clinical history of hemorrhagic manifestations.	If uses anticoagulant^* ⁎ Request exam and plan depending on the anticoagulant. Performing prothrombin time (TP) and activated partial thromboplastin time (aTPP) tests are not recommended routinely, as they do not estimate the risk of bleeding in the absence of clinical history of hemorrhagic manifestations.	If uses anticoagulant^* ⁎ Request exam and plan depending on the anticoagulant. Performing prothrombin time (TP) and activated partial thromboplastin time (aTPP) tests are not recommended routinely, as they do not estimate the risk of bleeding in the absence of clinical history of hemorrhagic manifestations. or has liver disease
	Renal function	Request if at risk for AKI	Yes	Yes

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

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[1] ⁎ Corresponding author at: Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil. E-mail address: grabello.inovaincor@fz.org.br (G. Rabello)