How should intraoperative blood loss be managed?

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Managing intraoperative blood loss means restoring both volume and the body’s ability to deliver oxygen to tissues. Fluids alone can help maintain preload, but they don’t replace the lost red blood cells or correct coagulation issues. That’s why giving blood products as needed is the best approach: red blood cells to restore oxygen-carrying capacity, and plasma or platelets as indicated to support coagulation. Using only balanced crystalloids or hypotonic solutions can dilute clotting factors, worsen hyponatremia, and fail to address anemia, while avoiding fluid replacement entirely is dangerous. In practice, monitor blood loss, hemodynamics, and labs, and transfuse blood products as indicated to maintain adequate oxygen delivery and hemostasis.