Bloodless Management of the Anemic Patient in the Emergency Department

Ann Emerg Med. 2022 Jan;79(1):48-57. doi: 10.1016/j.annemergmed.2021.06.015. Epub 2021 Aug 2.


Anemia is a commonly encountered condition in emergency medicine; transfusion of packed red blood cells is commonly performed for anemic patients in the emergency department (ED), but some patients are unable to accept transfusion of blood products due to medical or religious concerns. The unique, acute, and time-sensitive nature of emergency medicine practice requires that physicians maintain an enhanced awareness of bloodless medicine treatment modalities. Identification of bloodless medicine patient preferences in the ED can help guide physicians in the recommendation of acceptable methods of treating anemia in this patient population. A focus on early hemostasis and resuscitation, instead of attempts to convince the patient to accept blood transfusion, can be lifesaving in patients with acute bleeding. Treatment strategies including the use of methods to reduce unnecessary blood loss, enhance red blood cell production, and increase the oxygen-carrying capacity of blood should also be considered early in patient presentation. Timely involvement of the Hospital Liaison Committee can help facilitate successful interpersonal communication and shared decisionmaking between emergency physicians and bloodless medicine patients. By embracing an understanding of bloodless medicine patient needs as well as available treatment strategies, ED physicians can contribute to optimal overall outcomes for anemic bloodless medicine patients.

Publication types

  • Review

MeSH terms

  • Anemia / blood
  • Anemia / therapy*
  • Blood Substitutes / therapeutic use
  • Consent Forms
  • Decision Making, Shared
  • Dietary Supplements
  • Emergency Service, Hospital*
  • Erythrocytes / metabolism
  • Hemostatic Techniques*
  • Hemostatics / therapeutic use
  • Humans
  • Iron / therapeutic use
  • Patient Preference


  • Blood Substitutes
  • Hemostatics
  • Iron