To Transfuse or Not to Transfuse

18/08/2026

Tranexamic acid in hip fracture surgery: safe, effective and still underused.

Evidence supports TXA as an important Patient Blood Management strategy to reduce perioperative bleeding and the need for blood transfusion in patients undergoing hip fracture surgery. Available evidence is reassuring, with no clear increase in thrombotic complications.

Timing matters. Early administration on hospital admission, followed by intraoperative dosing, may provide greater benefit than intraoperative administration alone. Postoperative dosing appears to have a more limited role and may be reserved for selected patients with significant bleeding.

Key message: Consider TXA early, select the appropriate route and dose, and integrate it into a comprehensive PBM pathway for hip fracture care.

For healthcare professional education. Clinical use should follow local protocols and individual patient assessment.

References

1. Lasocki S, Campfort M, Léger M, Rineau E. Tranexamic acid in hip fracture repair surgery: safe and effective? Blood Transfus. 2025;23(1):83–86. doi:10.2450/BloodTransfus.933.

2. Taeuber I, Weibel S, Herrmann E, et al. Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression. JAMA Surg. 2021:e210884. doi:10.1001/jamasurg.2021.0884.

3. Lewis SR, Pritchard MW, Estcourt LJ, Stanworth SJ, Griffin XL. Interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews. Cochrane Database Syst Rev. 2023;6:CD013737.

4. Moran J, Kahan JB, Morris J, Joo PY, O’Connor MI. Tranexamic acid administration at hospital admission decreases transfusion rates in geriatric hip fracture patients undergoing surgery. Geriatr Orthop Surg Rehabil. 2022;13:21514593221124414.

16/08/2026

🩸 Ethical Foundations in Blood Transfusion

Every transfusion decision is more than a laboratory result or haemoglobin threshold — it is also an ethical clinical decision.

The four core principles of medical ethics remain central to transfusion practice:

🔹 Autonomy — respect informed consent, shared decision-making, and the patient’s right to accept or decline transfusion.
🔹 Beneficence — transfuse when there is a meaningful expected benefit to the patient.
🔹 Non-maleficence — avoid unnecessary transfusion and minimise preventable harm, including transfusion reactions, TACO, TRALI and alloimmunisation.
🔹 Justice — use donated blood responsibly and equitably as a precious, limited community resource.

This is where Patient Blood Management (PBM) becomes especially important: optimise the patient’s own blood, minimise blood loss, and transfuse only when the expected benefit outweighs the risk.

The best transfusion is not simply the one we can give — it is the one the patient truly needs.

15/08/2026

🩸 TO TRANSFUSE OR NOT?

Hb 7.6 g/dL — Does This Patient Need Blood?

A haemoglobin value alone should not automatically trigger red-cell transfusion.

In a haemodynamically stable patient without active bleeding, consider:

• Symptoms attributable to anaemia
• Evidence of ongoing or recent blood loss
• Cardiovascular and respiratory status
• Acute versus chronic anaemia
• Hb trend rather than a single value
• Underlying cause of the anaemia
• Whether iron, vitamin B12, folate or other treatment is appropriate
• Expected benefit versus potential risks of transfusion

🩸 Transfusion is a clinical decision, not simply a numerical one.

Whenever appropriate, identify and treat the cause of anaemia and use blood components only when the expected benefit outweighs the risk.

💡 PBM Pearl:
Treat the patient, investigate the anaemia, and transfuse only when indicated.

15/07/2026

Tranexamic Acid (TXA): Small Drug, Big Impact. 💉🩸

Every drop of blood matters.

Tranexamic acid (TXA) is a simple, affordable antifibrinolytic that helps reduce surgical bleeding, decreases the need for blood transfusions, and supports safer patient care. In settings with limited blood availability, TXA has the potential to save lives by preserving precious blood resources. Where blood supplies are adequate, it reduces healthcare costs and lowers exposure to transfusion-transmitted infections.

This infographic highlights how an evidence-based intervention can strengthen Patient Blood Management (PBM) by: 🩸 Reducing surgical blood loss
💉 Decreasing transfusion requirements
💰 Improving cost-effectiveness
❤️ Enhancing patient safety and outcomes

A small intervention can make a remarkable difference.

Evidence inspires better transfusion practice.


Reference :
Guerriero C, Cairns J, Jayaraman S, Roberts I, Perel P, Shakur H. Giving tranexamic acid to reduce surgical bleeding in sub-Saharan Africa: an economic evaluation. Cost Effectiveness and Resource Allocation. 2010;8:1. doi:10.1186/1478-7547-8-1.

09/07/2026

🩸 Washed Cell Salvage: Every Drop Counts
Reducing unnecessary allogeneic blood transfusions is a cornerstone of modern Patient Blood Management (PBM).
This systematic review and meta-analysis of 47 randomized controlled trials involving 3,433 surgical patients found that washed cell salvage: ✅ Reduced exposure to allogeneic red blood cell transfusion by 39% ✅ Reduced postoperative infections by 28% ✅ Shortened hospital stay by an average of 2.31 days ✅ Showed no increase in mortality, stroke, myocardial infarction, re-operation, or platelet/plasma transfusion
When significant blood loss is anticipated, washed cell salvage is an effective blood conservation strategy that helps preserve the patient's own blood while supporting better surgical outcomes.
Evidence-based transfusion practice begins with protecting the patient's own blood whenever possible.
📚 Reference: Meybohm P, Choorapoikayil S, Wessels A, et al. Washed cell salvage in surgical patients: A review and meta-analysis of prospective randomized trials under PRISMA. Medicine (Baltimore). 2016;95(31):e4490. �
PRISMA.pdf

07/07/2026

🩸👶 Patient Blood Management (PBM) in Neonates: More Than Just Transfusions

Neonates are among the most frequently transfused patients, yet they are often underrepresented in transfusion research. Patient Blood Management (PBM) reminds us that the goal is not simply to transfuse—but to provide the right treatment, for the right patient, at the right time.

The three pillars of neonatal PBM include:
🩸 Optimising the baby's own blood
🩸 Minimising blood loss
🩸 Improving tolerance of anaemia

Successful neonatal PBM requires a multidisciplinary approach involving neonatologists, transfusion medicine specialists, nurses, laboratory teams, surgeons, anaesthetists, and families. Every blood sample, every transfusion decision, and every intervention matters.

By embracing evidence-based PBM principles, we can improve patient outcomes, reduce unnecessary transfusions, and ensure safer, higher-quality care for our smallest patients.

📖 Reference
Crighton GL, New HV, Liley HG, Stanworth SJ. Patient blood management, what does this actually mean for neonates and infants? Transfusion Medicine. 2018;28(2):117–131.

27/06/2026

Patient Blood Management in Pediatrics: Small Patients, Big Responsibility ❤️🩸

Children are not simply "small adults." Their physiology, transfusion requirements, and response to treatment are unique, making Patient Blood Management (PBM) an essential part of delivering safe, evidence-based pediatric care.

Key principles include:
🩸 Early identification and treatment of anemia
🩸 Restrictive, evidence-based transfusion thresholds
🩸 Optimizing iron therapy and other alternatives to transfusion
🩸 Minimizing blood loss during surgery
🩸 Individualized transfusion decisions, especially for neonates and critically ill children

Every unit of blood should be given for the right patient, at the right time, for the right reason. By embracing PBM, we can improve outcomes, reduce unnecessary transfusions, and provide safer care for our youngest patients.

Because every drop counts—and every child matters. 💙

18/06/2026

Let’s talk about a "sacred cow" in medicine that we need to stop doing. 🚫🩸

​For years, the standard reaction to a low hemoglobin number was automatic: Order two units of packed red blood cells.
​But the data is clear: We are still over-transfusing patients, and it’s costing lives and healthcare dollars.
​The shift toward Patient Blood Management (PBM) isn't just a trend; it's a fundamental change in how we view human physiology. PBM views a patient’s own blood as a finite, precious organ that we need to protect, not replace at the first sign of an anemia "trigger."
​Here is what the latest clinical evidence actually tells us:
​❌ Myth: A transfusion is always the fastest way to fix anemia.
​✅ Fact: Aggressively treating iron deficiency before surgery reduces the need for transfusions by up to 40%.
​❌ Myth: Transfusions are inherently benign.
​✅ Fact: Every unit of blood carries risks of fluid overload, transfusion reactions, and longer hospital stays.
​Implementing a strict PBM protocol isn’t just about saving blood; it’s about improving surgical outcomes, reducing length of stay, and practicing truly evidence-based medicine.
​Is your team still relying on traditional transfusion triggers, or have you made the switch to active PBM? Let's talk in the comments. 👇
​

17/05/2026