Table 1. Management strategies for... | American Society of Hematology

Table 1.

Management strategies for individuals with rare blood group such as O_h blood group

Strategies	Requirements	Possibility in this case
Preoperatively
Autologous donation	Hb ≥ 11 g/dL HCT ≥ 33% Time before surgery	Not possible as patient’s Hb was <10 g/dL persistently.
Directed donation	Identify O_h blood group donors (related or unrelated) Identify blood centers with available units	Family member was identified with similar blood group; however, she was unable to donate due to low Hb levels (10 g/dL). Blood centers in the vicinity were contacted to inquire about any available O_h blood units. Local nongovernmental organization was contacted for any O_h donors willing to donate if needed.
Preoperative optimization of Hb	Erythropoietin-stimulating agents Nutritional optimization	Patient’s serum iron levels were low (34.8 μL/dL), whereas serum ferritin levels were normal. Hence, she was given IV iron supplements preoperatively, which increased the patient’s Hb from 9.2 g/dL to 10 g/dL within a span of 2 months.
Formulate patient-specific management plan	Estimate expected blood loss during surgery	Patient was evaluated for expected blood loss (∼300-400 mL), which was not significant because the tumor was not highly vascular nor was it near any major blood vessels.
Intraoperatively
Optimize surgical technique	Experienced surgeons	Senior surgeons were handling the case.
Intraoperative cell salvage	Intraoperative cell salvaging machine	Not available in hospital
Postoperatively
Minimize blood loss (iatrogenic)	Minimize the number and volume of blood samples	Blood samples were taken only for essential investigations. Point of care tests were used whenever possible.
Improve tolerance to low blood counts	Restrictive transfusion strategy	Low Hb threshold (6 g/dL) along with symptom-based approach was used
	Goal-based transfusion strategy	Thromboelastography-guided transfusion strategy was used to optimize transfusion
	Treat infections promptly	Patient was immediately admitted, and the treatment for infection was initiated swiftly

Strategies	Requirements	Possibility in this case
Preoperatively
Autologous donation	Hb ≥ 11 g/dL HCT ≥ 33% Time before surgery	Not possible as patient’s Hb was <10 g/dL persistently.
Directed donation	Identify O_h blood group donors (related or unrelated) Identify blood centers with available units	Family member was identified with similar blood group; however, she was unable to donate due to low Hb levels (10 g/dL). Blood centers in the vicinity were contacted to inquire about any available O_h blood units. Local nongovernmental organization was contacted for any O_h donors willing to donate if needed.
Preoperative optimization of Hb	Erythropoietin-stimulating agents Nutritional optimization	Patient’s serum iron levels were low (34.8 μL/dL), whereas serum ferritin levels were normal. Hence, she was given IV iron supplements preoperatively, which increased the patient’s Hb from 9.2 g/dL to 10 g/dL within a span of 2 months.
Formulate patient-specific management plan	Estimate expected blood loss during surgery	Patient was evaluated for expected blood loss (∼300-400 mL), which was not significant because the tumor was not highly vascular nor was it near any major blood vessels.
Intraoperatively
Optimize surgical technique	Experienced surgeons	Senior surgeons were handling the case.
Intraoperative cell salvage	Intraoperative cell salvaging machine	Not available in hospital
Postoperatively
Minimize blood loss (iatrogenic)	Minimize the number and volume of blood samples	Blood samples were taken only for essential investigations. Point of care tests were used whenever possible.
Improve tolerance to low blood counts	Restrictive transfusion strategy	Low Hb threshold (6 g/dL) along with symptom-based approach was used
	Goal-based transfusion strategy	Thromboelastography-guided transfusion strategy was used to optimize transfusion
	Treat infections promptly	Patient was immediately admitted, and the treatment for infection was initiated swiftly

HCT, hematocrit.