Although the number of voluntary blood donors in China has been increasing in recent years, seasonal “blood shortages” occur in some major cities during the summer (July-August) and winter (December-February), which are often the peak periods for orthopedic spine surgery. In order to achieve the goal of rational blood use and bloodless medical treatment, one of the most important measures is to actively and extensively implement blood management in the perioperative period. Perioperative blood management is the use of different, or a combination of techniques for the qualitative and quantitative conservation of blood and the reduction of blood loss during all phases of the perioperative period. One of the important aspects of blood management is the strict mastery of transfusion indications (see previous section), followed by different emphases in the preoperative, intraoperative and postoperative periods. In addition, emphasis should be placed on the intervention of relevant drugs. Preoperative: patient selection and preparation and preoperative pre-storage of autologous blood Based on the concept of blood management, the surgeon should consider not only the indications and contraindications for surgery during the outpatient evaluation, but also the assessment of red blood cell reserves and risk factors associated with blood loss. Measure 1: Improving the patient’s preoperative red blood cell count includes early diagnosis and correction of preoperative anemia. Iron deficiency anemia and anemia associated with chronic inflammation and degenerative disease are common in the elderly. Frequent testing and targeted etiologic therapy are desirable. The administration of erythropoietin (EPO) and iron is an expensive but effective measure to increase preoperative red blood cell counts. We routinely give oral iron to patients with preoperative anemia, and EPO and iron to those who are suitable for preoperative prestorage autologous blood transfusion (PABD). Measure 2: The coagulation status of the patient should be observed preoperatively. Prior to elective or non-emergency surgery, patients should discontinue anticoagulants (e.g., warfarin, clopidogrel, aspirin) or proceed to surgery after the effects of anticoagulants have subsided. The use of vitamin K or warfarin antagonists may be avoided with fresh frozen plasma (FFP). Orthopedic patients often use non-steroidal anti-inflammatory drugs (NSAIDs) for a long time, which can affect coagulation and need to be reasonably discontinued before surgery. Measure 3: For major orthopedic surgeries, especially those with high blood loss, there is also a preoperative general consultation system, and a group effort is made to scientifically grasp the surgical indications and formulate the surgical plan. For surgeries with blood transfusion volume greater than 1200 ml, the signature of the chief of the department is required and it is reported to the medical office for record. This system is very helpful in reducing the chance of blood transfusion, especially accidental transfusion. Despite tremendous advances in surgical techniques and intraoperative medications, blood loss in orthopedic surgery is still high, as the following measures should be emphasized during surgery Measure 1: Orthopedic surgeons apply superb surgical techniques to stop bleeding in order to reduce intraoperative blood loss. It is especially important to pay attention to every detail of the surgical procedure, including postoperative position, elevation of the affected limb, choice of anesthesia, maintenance of patient 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 the Department of Orthopedics of our hospital. Measure 2: Surgical patients often have volume loss and deficiency before surgery, and even more volume loss during and after surgery, so patient volume reserve is a prerequisite for maintaining circulation, and establishing the view that volume comes first can reduce the risk of intraoperative transfusion. Hemodilution is an extension of volume therapy. For major surgery, acute isovolumetric hemodilution or high volume hemodilution is used for patients 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 flow control and maintain circulatory function, while hemodilution itself can also improve circulation and increase tissue oxygen supply and Oxygenation. We have used this approach in some of our orthopedic spine patients and have significantly reduced the proportion of allogeneic blood transfusions. Measure 3: Intraoperative blood recovery (CS) holds great promise, as it reduces allogeneic transfusion by reducing the amount of blood lost intraoperatively. There is a large amount of blood leakage from traumatic surfaces after orthopedic surgery, such as posterior spine surgery, arthroplasty or joint revision. There are three clinical measures for postoperative wound drainage management: Measure 1: “Plugging” – no drainage is placed, believing that placement of drainage does 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 drainage, believing that placing drainage reduces postoperative ecchymosis and blood leakage, while relieving the patient’s psychological burden of wound bleeding. Measure 3: “Turning waste into treasure” – Performing postoperative autologous drainage blood transfusion back, which can reduce both postoperative wound ecchymosis and bleeding and allogeneic transfusion. The above clinical trials confirm the benefits of blood management. Blood management measures are again comprehensive, and in most cases, a single measure alone is often ineffective. Safe and feasible methods that are easy to operate should be selected in conjunction with the patient’s condition, the surgery, and the available technical and equipment conditions, and combined techniques should be used scientifically and rationally to strive for optimal benefits.