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”
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