Surgical management of patients with severe anaemia due to acute blood loss: a case for withholding perioperative blood transfusion.

Twenty one consecutive patients who had an average packed cell volume (PCV) of 16.2% (range 13-25) due to acute blood loss were treated surgically without perioperative blood transfusion. All the surgical procedures were carried out under intravenous ketamine hydrochloride. The surgical wound in each patient healed by primary intention. The packed cell volume rose to 35% and above in an average of six weeks by use of oral haematinics. The only morbidity observed was dizziness which lasted for an average of six days in ten patients. There were no deaths and all the patients remained well at an average follow-up period of 42 weeks. The study shows that perioperative blood transfusion can be avoided in surgical care of most patients who have severe anaemia due to acute blood loss without mortality and without significant morbidity.