CPB as well as surgical trauma have a significant impact on the usually well-balanced coagulation system. This often leads to bleeding complications, and interventions to restore this balance are frequently attempted perioperatively. The coagulation and inflammatory systems are so complex that restoration of homeostatic balance cannot be achieved by giving blood products alone. Major known causes of CPB associated coagulopathy are dilution, complex and variable platelet dysfunction, fibrinolysis, the effects of heparin and protamine, hypocalcemia, hypothermia, as well as activation of the coagulation system after contact with artificial surfaces and from tissue factor release from the endothelium in response to ischemia and reperfusion.

Key Learning Points

1. 1. Right blood, right patient, right time and right place is the key message for safe blood administration.

2. 2. Accidental transfusion of ABO-incompatible blood is classified as a ‘never event’.

3. 3. Most errors could be prevented by a final bedside check when performed correctly.

4. 4. Patient blood management has three pillars of focus to reduce unnecessary transfusions: recognition and treatment of anaemia, minimisation of bleeding and blood loss and optimisation of anaemia and transfusion thresholds.

5. 5. Unnecessary delays in transfusion can lead to death and major morbidity.