NHS Blood & Transplant has declared an Amber alert for group O red cells and called for implementation of emergency blood management arrangements.

Visit the NHS Blood & Transport website for further information and guidance. 

Read CPOC's perioperative Anaemia guidance, developed using a whole pathway approach. It contains recommendations for patients of all ages undergoing surgery and for health care professionals in both emergency and elective surgical settings and across specialties.

Other resources may also be useful:

• BMJ article about the perioperative use of tranexamic acid led by Professor Ian Roberts

For preoperative assessment teams / perioperative physicians:

1. Identify patients who are at risk of anaemia as early as possible in preoperative elective pathways. Treat anaemia with iron, B12 and/or Folate as required

For surgeons and ward teams in general:

1. Minimise iatrogenic anaemia, take samples from patients only if this will change clinical management
2. Where possible, use a restrictive red cell transfusion threshold, haemoglobin of 70 g/L unless patient is bleeding, has acute coronary syndrome, or is on a chronic transfusion programme
3. Where possible transfuse one unit
4. Send G&S on bleeding patients and switch to group specific as soon as possible

For anaesthetists / theatre teams:

1. Consider tranexamic acid in all patients having major surgery - X post 
2. Administer if risk of perioperative blood loss likely to be >500ml
3. Where possible and required, transfuse one unit only before reassessing