What is Patient Blood Management?

Patient Blood Management is a means of patient care that reduces the need for blood transfusion.

Cleveland Clinic nurses and doctors provide Patient Blood Management as a normal part of your care. They can help you decide which of the following options are best for your condition.

Options for Patient Blood Management:

  • Medications and supplements to increase your blood cells.
  • Treatment to prevent or reduce bleeding.
  • Recycle your own blood during surgery.
  • Lower the amount of blood taken from you for lab tests.
  • When needed blood transfusion.

Contact us

If you have questions or need more information, contact us at bldmgmt@ccf.org. Please allow 48-72 hours for a reply.

Frequently Asked Questions

Frequently Asked Questions

Please note: This information does not replace the medical advice of your healthcare provider and is for educational purposes only.

Why do I need a blood transfusion?

Your blood has many parts (or components), such as red blood cells, platelets, plasma, and plasma proteins.

  • Red blood cells carry oxygen through the body.
  • Platelets and plasma help blood to clot.

If your body does not make enough blood components, or you lose them from bleeding, they may need to be replaced. This is usually done by giving you components (for example, red blood cells, platelets or plasma) from someone else’s blood. Your doctor will prescribe a transfusion for you only if it is necessary.

How safe are blood transfusions?

People who donate blood are asked questions about their health, behavior, and travel. The donated blood is tested for disease. Only blood that has passed these strict steps can be given to another person.

The chances of getting a disease from blood transfusion are very, very low. For example, the risk of HIV or hepatitis C infection from one unit are only 1in 1-2 million. This is lower than the risk of being struck by lightning (1 in 700,000).

There are some side-effects (reactions) of blood transfusion. The most common are fever, chills, rash, or fluid overload. Your doctor will discuss the risks and benefits of transfusion for your condition. You will be given a transfusion only if it is necessary, and you will be carefully watched for any side effects.

Are there alternatives?

Yes, your doctor will discuss the alternatives available for your condition.

Sometimes medications can be used to help your body make its own blood or to stop bleeding. If you are seriously ill or have heavy bleeding, these alternatives may be too slow, and you may need a blood transfusion.

Can I refuse transfusion?

Yes, but refusing a transfusion that your doctor has prescribed can cause you serious harm. If you refuse transfusion, your doctor or nurse will explain the risks to you so that you can make a good decision.

What can I expect during the transfusion?

Before the transfusion is started, a nurse will check your (blood pressure, pulse, and temperature). Nurses will match your identification band to the blood component bag to make sure that you are given the right bag. The blood component will be given through an IV line.

During the transfusion, the nurse will watch you carefully for any side effects and will check your blood pressure, pulse, and temperature.

Depending upon the blood component and your medical condition, the transfusion can take from 15 minutes to 4 hours.

How do I know if I am having a reaction?

During and after transfusion, your nurse will watch you closely for a reaction. If you have a reaction, the transfusion will be stopped.

These are some common symptoms of a transfusion reaction.

  • Severe back pain.
  • Fever, chills or feeling warm.
  • Vomiting or feeling sick.
  • Rash, hives, itching.
  • Fast heartbeat.
  • Trouble breathing, wheezing.

Some reactions can occur days or weeks after the transfusion. You will be given instructions at discharge.

What happens after the transfusion?

If you have any of the reactions listed above, tell your nurse or provider immediately.

If you have been discharged from the hospital and have symptoms that may be a reaction to blood, contact your provider immediately. If you are unable to reach your provider, call 911 or go to the nearest Emergency Room.

After your transfusion, rest for 24 to 48 hours. Once you are discharged, make a follow-up appointment with your provider.

Preparing for Surgery

Preparing for Surgery

Understanding your blood needs

Talk to your surgeon about blood transfusion. The following questions might be helpful for your discussion:

  • How often is blood transfusion needed with this surgery?
  • How much blood will be lost during and after surgery?
  • Can my own blood be recycled during surgery?
  • Are there treatments to lower the need for blood transfusion?
  • Is there anything I can do before surgery to build-up my blood?
  • If I need a transfusion, which blood components will I need?
  • How will they help?
  • What is the risk?

Anemia before surgery

Talk to your surgeon about anemia or checking for low blood iron if:

  • Recent or chronic blood loss.
  • History of low blood counts or anemia.
  • Low body weight (less than 130 lbs.).
  • Female.
  • Heart problems.
  • Kidney disease.
  • Diabetes.
  • Cancer treatment (past 6 months).
  • Nutritional deficiencies (gastric bypass, Crohn's disease, celiac, chronic diarrhea, short bowel syndrome, diagnosed with slow moving intestines).
  • Gastric reflux (heartburn) on medication.
  • Medications: antacids, thyroid, cholesterol-lowering, calcium supplements, pancreatic enzymes.
  • History of travel to tropical countries and infections with intestinal parasites and helminths.

You may also be checked for a B12 deficiency if you are more than 60 years old, are on an exclusively vegetarian diet, are taking medications like metformin, and have a history of pernicious anemia, Crohn’s disease, bacterial overgrowth, etc.

If there is time (at least 2 weeks, ideal 4-6 weeks) before surgery, it may be possible to help your body make blood through diet and medications. Low blood iron levels can be corrected.

  • Synthetic erythropoietin: a hormone that helps make red blood cells.
  • Iron therapy: a mineral required for making red blood cells.
  • B12, folic acid, and Vitamin C: vitamins needed to make red blood cells.

During surgery

There are many ways to lower blood loss during surgery. A surgeon can use techniques to decrease blood loss. It may be possible to collect the blood lost during surgery, wash it, and give it back to you.

After surgery

A good diet and/or medications may be used after surgery to help with recovery.



Anemia or low blood levels can be caused by bleeding, inflammation, lack of nutrients, medications, or a combination. The most common type of anemia is caused by iron deficiency and can be treated.

Symptoms of anemia

  • Tiredness.
  • Fast heartbeat.
  • Shortness of breath.
  • Headache.
  • Dizziness.
  • Pale skin.
  • Leg cramps.
  • Inability to sleep.

Risk factors for iron deficiency

  • Bleeding.
  • Antacids.
  • Thyroid medication.
  • Weight loss surgery.
  • Crohn’s disease or ulcerative colitis.
  • Heavy periods.
  • Pregnancy.
  • Celiac disease.
  • History of duodenal surgery (Whipple, etc.).


Iron deficiency is treated with iron. This can be done through diet, iron pills, or intravenous iron depending on the severity. Your provider can help determine what treatment is best for you.

How the Patient Blood Management nurse coordinator can help

Our nurse coordinator works with you and your doctor to manage your anemia. If you require IV iron, the nurse can make the arrangements whether you are local to a Cleveland Clinic facility or from out of town. The nurse can also answer questions about anemia and Patient Blood Management, and offer instruction.

Refusing a Blood Transfusion

Refusing a Blood Transfusion

Cleveland Clinic defines “blood is not an option” or “blood product refusal” as the refusal of blood regardless of medical condition even if a transfusion may sustain life.

If you want to refuse a blood transfusion, please follow these steps when when scheduling surgery or as you are admitted to the hospital:

  • Tell a doctor or nurse you refuse blood.
  • Complete a Blood Product Refusal form. You may print and complete the form to bring with you to the hospital.
  • Have a copy of your advanced directive placed in your chart.

What to expect as a patient

Your decision regarding blood products will be honored.

Doctors have a legal & moral duty to make sure you understand what may happen by not taking blood. They must make sure this decision is your own.

You may be asked about blood when:

  • Condition changes.
  • Treatment would normally include blood.

If you have questions or need more information, contact us at bldmgmt@ccf.org. Please allow 48-72 hours for a reply.

For Florida patients

Honoring Patient Wishes

The patient blood management program addresses the needs of patients who do not want to be treated with blood products, whether for religious reasons or safety concerns.

For these patients, Martin Health has established a protocol for the organization’s three hospitals: Martin Medical Center and Martin Hospital South in Stuart, and Tradition Medical Center in Port St. Lucie. When the patient identifies as refusing blood products at the time of admission, they complete a “No Blood Advanced Directive for Health Care.” This is captured and flagged in the patient’s electronic medical record and they receive a special patient wrist band.

A team of physicians from many specialties within the organization is trained to treat patients who want alternatives to blood transfusion strategies. A multidisciplinary clinical team is consulted to develop alternative clinical options for this patient.



All Cleveland Clinic hospitals in the United States have Patient Blood Management. The location where you receive blood transfusions is based on which hospital your surgery takes place at.

Our Regional Hospitals