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    Maximum Allowable Blood Loss (ABL) Without Transfusion

    Estimates the maximum allowable blood loss intraoperatively before transfusion should be considered.
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    lbs
    g/dL
    g/dL

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    Advice

    • During blood loss, dilution of remaining hemoglobin occurs as intravascular volume is maintained by fluid shifts and administration of fluids.
    • Consider transfusing if estimated blood loss exceeds calculated allowable blood loss.

    Management

    • Estimating blood loss intraoperatively can be done via direct measure of blood in suction canister along with measuring soiled sponges.
    • This method is only an estimate to measure blood loss. Patient vitals and clinical signs should be evaluated clinically first.
    • Capacity by sponge type:
      • 4x4s: ~10 mL blood
      • Gauze sponges (Ray-Tec):~10-20 mL blood
      • Laparotomy (lap) sponges: ~50-100 mL blood
    • Consider timing of blood loss. Acute blood loss may not present with a drop in hemoglobin. Always monitor clinical metrics such as hemodynamics and respiratory status along with anticipated blood loss.
    • The trigger to transfuse varies by patient.
    Content Contributors
    • Amit Patel, MD