Mastering the trio: A holistic approach to patient blood management in juvenile nasopharyngeal angiofibroma

Abstract: Patient blood management (PBM) is an evidence-based, multidisciplinary approach designed to enhance patient outcomes by addressing anemia, minimizing blood loss, and using allogeneic blood transfusions judiciously. In this case, an 18-year-old male with juvenile nasopharyngeal angiofibroma (JNA) and recurrent nasal bleeding was prepared for elective surgery. JNA patients are usually anemic due to repeated bleeding episodes, and it being a highly vascular tumor is prone to increased bleeding during surgery, making it an ideal diagnosis for application of PBM principles. Preoperative hemoglobin (Hb) was 8.4 g/dL due to iron deficiency anemia, which was corrected to 14.6 g/dL using intravenous iron therapy. Two units of autologous blood were collected, and during surgery, the patient experienced a 1-L blood loss but required no allogeneic transfusions. Postoperative Hb was 11.2 g/dL, and he was discharged on postoperative day 3. Key strategies included preoperative anemia correction, autologous transfusion, tranexamic acid to reduce bleeding, and close postoperative monitoring. This case highlights the importance of PBM in improving outcomes, reducing the need for allogeneic transfusions, and minimizing surgical risks, thus laying a roadmap for application in similar vascular tumours.