People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Healthcare professionals should follow our general guidelines for people delivering care:
Do not offer erythropoietin to reduce the need for blood transfusion in people having surgery, unless:
the person has anaemia and meets the criteria for blood transfusion, but declines it because of religious beliefs or other reasons or
the appropriate blood type is not available because of the person's red cell antibodies. [2015]
Offer oral iron before and after surgery to people with iron‑deficiency anaemia. [2015]
Consider intravenous iron before or after surgery for people who:
have iron‑deficiency anaemia and cannot tolerate or absorb oral iron, or are unable to adhere to oral iron treatment
are diagnosed with functional iron deficiency
are diagnosed with iron‑deficiency anaemia, and the interval between the diagnosis of anaemia and surgery is predicted to be too short for oral iron to be effective. [2015]
For guidance on managing anaemia in people with chronic kidney disease, see NICE's guideline on chronic kidney disease: assessment and management. [2015]
Offer tranexamic acid to adults having surgery in an operating theatre if:
there is any risk of bleeding and
the procedure will breach the skin or mucous membranes. [2026]
Offer tranexamic acid to adults having surgery outside an operating theatre (for example, interventional radiology or A&E) who are expected to lose more than 500 ml of blood. [2026]
When using tranexamic acid for adults having surgery, administer it just before the start of surgery. Typically give 1 g by slow intravenous injection. [2026]
For information about using tranexamic acid for primary hip, knee and shoulder replacement in adults, see NICE's guideline on joint replacement (primary). [2015]
Consider tranexamic acid for children (aged 1 to 15 years) having surgery in an operating theatre if:
there is any risk of bleeding and
the procedure will breach the skin or mucous membranes. [2026]
Consider tranexamic acid for children (aged 1 to 15 years) having surgery outside an operating theatre (for example, interventional radiology or A&E) who are expected to lose more than 10% of their blood volume. [2026]
When using tranexamic acid for children (aged 1 to 15 years) having surgery, administer it just before the start of surgery. Typically give 15 mg per kg (maximum 1 g) by slow intravenous injection. [2026]
If more than 1 dose of tranexamic acid might be beneficial because of the length of surgery or volume of blood loss, balance this against any risks associated with additional doses. Risks may include tranexamic acid accumulating in the blood for people with renal impairment. [2026]
Ensure safety measures are in place to prevent tranexamic acid from being accidentally administered via the intrathecal or epidural route rather than intravenously. [2026]
For a short explanation of why the committee made the 2026 recommendations and how they might affect practice, see the rationale and impact section on tranexamic acid.
Full details of the evidence and the committee's discussion are in evidence review A: tranexamic acid for reducing anticipated minor blood loss due to surgery and evidence review B: safety of tranexamic acid during surgery.
Consider intra-operative cell salvage with tranexamic acid for people who are expected to lose a very high volume of blood (for example, in cardiac and complex vascular surgery, and pelvic reconstruction and scoliosis surgery). [2015]
Do not routinely use cell salvage without tranexamic acid. [2015]