AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 40 Given the importance of anaemia screening, diagnosis and treatment in a successful PBM programme, the value of the primary healthcare level/general practitioners should not be underestimated, nor should they be excluded from the PBM plan. The availability of alternatives (e.g. cell-saver technology) or pharmaceuticals (e.g. tranexamic acid) should always be considered and strived for, even in rural settings. Table 1.2 Pillar 1: Optimise red cell mass Pillar 2: Minimise blood loss and bleeding Pillar 3: Harness and optimise the physiological reserve of anaemia Pre-operative phase • Detect anaemia • Identify the underlying disorder/s causing anaemia • Manage disorder/s • Refer for further evaluation if necessary • Treat suboptimal iron stores/iron deficiency/anaemia of chronic disease/iron-restricted erythropoiesis • Treat other haematinic deficiencies Note: Anaemia is a contra-indication for elective surgery • Identify and manage bleeding risk • Minimise iatrogenic blood loss • Plan and rehearse procedure • Assess/optimise patients’ physiological reserve and risk factors • Compare estimated blood loss with patient-specific tolerable blood loss • Formulate patient-specific management plan using appropriate blood-conservation modalities to minimise blood loss, optimise red cell mass and manage anaemia Intra-operative phase • Time surgery with haematological optimisation • Employ meticulous haemostasis and surgical techniques • Use blood-sparing surgical device/s • Use anaesthetic blood-conserving strategies • Choose autologous blood options • Maintain normothermia • Use pharmacological/haemostatic agents • Optimise cardiac output • Optimise ventilation and oxygenation Post-operative phase • Optimise erythropoiesis • Be aware of drug interactions that can increase anaemia • Vigilantly monitor and manage post- operative bleeding • Avoid secondary haemorrhage • Employ rapid warming/maintain normothermia (unless hypothermia is specifically indicated) • Employ autologous blood salvage • Minimise iatrogenic blood loss • Manage haemostasis/anticoagulation • Employ prophylaxis of upper gastro- intestinal (GI) haemorrhage • Avoid infections or treat promptly • Be aware of adverse effects of medication