Abdul Mannan: A Three-Pillar Strategy for Surgery Without Transfusion
Dr Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board, posted on LinkedIn:
“How do you manage a major surgery when blood transfusion is impossible?
Whether due to religious beliefs (like Jehovah’s Witnesses) or rare antibodies, the “untransfusable patient” presents one of medicine’s greatest challenges. We lose our safety net.
To explain the solution—Patient Blood Management (PBM)—I use this simple analogy:
It’s like driving a long road trip through a desert with NO petrol stations.
As shown in the infographic below, we survive the journey using 3 Core Pillars:
- Fill the Tank (Pre-op): We aggressively optimise red cell mass weeks in advance (IV Iron, vitamins, EPO). We don’t leave until the tank is full.
- Don’t Spill a Drop (Intra-op): We drive efficiently. Surgeons use meticulous techniques and “cell salvage” to recycle the patient’s own blood immediately.
- Eco-Mode (Post-op): If the fuel gauge hits empty, we minimise metabolic demand (sedation, cooling) to survive on fumes until the body recovers.
The foundation of it all? Respect and Informed Consent.
We must understand exactly what the patient accepts to treat them safely and ethically.
Check out the graphic below for the full breakdown.
The Blood Doctor”

Follow the latest in Hemostasis Today.
-
May 12, 2026, 16:46Tagreed Alkaltham: Why Apheresis Matters in Modern Transfusion Medicine
-
May 12, 2026, 16:37Reinhold Kreutz: Cardiovascular Burden in Acute Intermittent Porphyria Needs Greater Awareness
-
May 12, 2026, 16:33Pablo Corral: The Truth About Very Low LDL-Cholesterol
-
May 12, 2026, 16:24Mildred Lundgren: We Must Talk About the Invisible Causes of Stroke
-
May 12, 2026, 16:17Irene Scala: The Sex Disparities In Access to Acute Stroke Treatments In Italy
-
May 12, 2026, 16:04May Nour: UCLA Health Mobile Stroke Unit Becomes The 1st In The World to Perform mCTA In the Field
-
May 12, 2026, 15:57Leonardo Roever: Prognostic Impact of Lipoprotein(a) and CAR in Elderly Acute Ischemic Stroke Patients
-
May 12, 2026, 15:54Bruno Pougault: Prioritizing Laboratory Tests in Resource-Limited Emergency Care
-
May 12, 2026, 15:37Jennifer Holter Chakrabarty: Supporting the Next Generation of Hematology Researchers