Global blood management in orthopaedic surgery.

Blood loss tends to be significant in many orthopaedic procedures because of the nature of the tissues and the inability to cauterize or coagulate bleeding bony surfaces. Regional hypotensive anesthesia has been useful in reducing blood loss particularly for joint replacement. A spectrum of measures is available to retrieve autologous blood and reinfuse it. The loop consists of predeposit autologous blood, preoperative hemodilution, intraoperative and postoperative red cell retrieval, and reinfusion. The safety of autologous blood has been accepted universally, but the measures to preserve it must be used judiciously to avoid excessive cost and, most importantly, ensure patient safety.