Although the number of voluntary blood donors has been increasing in recent years, seasonal “blood shortage” occurs in some big cities in the summer (July-August) and winter (December-February), and the winter and summer are often the peak periods for orthopedic spine surgery. In order to achieve the goal of rational use of blood and bloodless medical treatment, one of the most important measures is to actively and extensively carry out blood management in the perioperative period. Perioperative blood management refers to the adoption of different, or combined use of multiple techniques for qualitative and quantitative blood conservation and reduction of blood loss at various stages of the perioperative period. One of the important aspects of blood management is the strict control of transfusion indications (see previous section for details), followed by preoperative, intraoperative and postoperative phases, each with a different focus. In addition, emphasis should be placed on relevant pharmacologic interventions. Preoperative: patient selection and preparation and pre-storage of autologous transfusion Based on the concept of blood management, the surgeon should consider not only the indications and contraindications for surgery, but also the assessment of red blood cell reserve and risk factors associated with blood loss during the outpatient evaluation. Measure 1: Improvement of the patient’s preoperative red blood cell count includes early diagnosis and correction of preoperative anemia. Iron deficiency anemia and anemia associated with chronic inflammatory and degenerative conditions are common in the elderly. Frequent testing and targeted etiologic therapy are desirable. Administration of erythropoietin (EPO) and iron is an expensive but effective measure to increase preoperative red blood cell counts. We routinely administer oral iron to patients with preoperative anemia, and we give EPO and iron to those who are candidates for preoperative autologous blood transfusion (PABD). Measure 2: Patients should be observed preoperatively for coagulation status. Patients should discontinue anticoagulants (e.g., warfarin, clopidogrel, aspirin) before elective or nonemergency surgery, or after the effects of anticoagulants have subsided. The use of fresh frozen plasma (FFP) can be avoided with the use of vitamin K or warfarin antagonists. Orthopedic patients are often on long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), which can affect coagulation and need to be reasonably discontinued preoperatively. Measure 3: For major orthopedic surgeries, especially those with high blood loss, there is also a preoperative general medical checkup system, which is a group effort to scientifically grasp the indications for surgery and formulate surgical plans. For surgeries in which the amount of blood transfusion is greater than 1200ml, the signature of the chief of the department is required to be submitted to the medical office for record. This system is very helpful to reduce the chance of blood transfusion, especially accidental blood transfusion. Despite the tremendous progress in surgical techniques and intraoperative medications, blood loss in orthopedic surgeries is still large because the following measures should be emphasized to be used during surgery. Measure 1: Orthopedic surgeons apply excellent surgical techniques to stop bleeding to minimize intraoperative blood loss. It is especially important to pay attention to every detail of the surgical process, including postoperative position, elevation of the affected limb, choice of anesthesia, maintenance of the patient’s body temperature during surgery, and tourniquet use. Some surgical techniques, including argon knife, electrocautery, bipolar electrocoagulation for hemostasis, and local use of hemostatic gauze, can safely and effectively reduce blood transfusion. With the strong cooperation of the Department of Anesthesiology, intraoperative controlled hypotensive anesthesia has been widely carried out in our orthopedic department. Measure 2: Surgical patients often have volume loss and insufficiency preoperatively, and even more volume loss intraoperatively and postoperatively; therefore, patient volume reserve is a prerequisite for maintenance of circulation, and the establishment of a volume-first viewpoint can reduce the risk of intraoperative blood transfusion. Hemodilution is an extension of volume therapy. For major surgery, acute isovolumetric hemodilution or high volumetric hemodilution is used under anesthesia, so that the patient’s intraoperative bleeding is “anemic” blood, reducing the loss of whole blood in the body, which can achieve open-source throttling and maintenance of the circulatory function, and the hemodilution itself can improve the circulation and increase the supply of oxygen to the tissues and oxygenation. Oxygenation. We have used this method in some of our spinal orthopedic patients and have significantly reduced the proportion of allogeneic blood transfusions. Measure 3: Intraoperative blood recovery (CS) is promising, as it reduces allogeneic blood transfusion by decreasing the amount of blood lost intraoperatively. Orthopedic surgery is characterized by high blood leakage from postoperative wounds, such as posterior spinal surgery, arthroplasty or revision arthroplasty. There are three clinical measures for the management of postoperative wound drainage: measure 1: “Plugging” – not placing drainage, which is considered to not reduce the rate of hematoma formation and wound exudation, while increasing postoperative blood loss, thus increasing the rate of allogeneic transfusion measure 2: “Sparing” – placing drains, arguing that placing drains reduces postoperative petechiae and oozing while relieving the patient’s psychological burden of wound oozing. Measure 3: “Turning waste into treasure”-performing postoperative autologous drainage and blood transfusion back to reduce both postoperative wound ecchymosis and blood seepage as well as allogeneic blood transfusion. The above clinical trials confirm the benefits of blood management. The measures of blood management are again comprehensive, and in most cases, a single measure alone is often not effective. Safe and feasible methods that are easy to operate should be selected in the light of the patient’s condition, the surgical situation, and the existing technical and equipment conditions, and combined techniques should be used scientifically and rationally in order to strive for optimal benefits.