Surgery is planned ahead of time, with a clear blood plan and a team that agrees to follow it. The key steps are early planning, careful consent, and blood-saving methods before, during, and after surgery. For elective surgery, this should be done in the anesthesiology preoperative clinic because it takes more time. Your team should document which blood products, blood fractions, and procedures are acceptable to you, such as cell salvage or certain clotting factors. The whole surgical team needs to understand the plan. If no team can agree to it, you may need referral to another hospital.

Typical planning also includes checking for anemia 2 to 4 weeks before surgery, correcting iron deficiency, and replacing vitamin B12 or folate if needed. The plan may also include stopping antiplatelet or anticoagulant medicines and herbal products that raise bleeding risk, and preparing blood conservation methods like acute normovolemic hemodilution and cell salvage.

If you are an adult with decision-making capacity, you have the legal right to decline transfusion. Verify the exact plan with your surgical or anesthesia team in case they want something different for you.