Methods and devices for reducing transfusions during or after surgery and for improving quality of life and function in chronic disease

• US 9,679,115 B2
• Filed: 02/02/2011
• Issued: 06/13/2017
• Est. Priority Date: 02/02/2010
• Status: Active Grant

• Current Assignee: Accumen Inc.
• Original Assignee: Kathrine P. Frey
• Inventors: Frey, Kathrine P.
• Primary Examiner(s): Lam, Eliza
• Application Number:
  US13/576,874
• Publication Number:
  US 20130035951A1
• Time in Patent Office: 2,323 Days
• Field of Search: 705 2- 3
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

The present Invention relates to methods of treating subjects preparing to undergo surgery or methods of treating chronic disease and methods for reducing transfusions and a computer readable storage medium and a physical computing device for carrying out these methods which include: a) receiving a profile of said subject, in a physical computing device, including a level of hemoglobin of said subject, level of creatinine of said subject, and information regarding current or past history of disease; b) applying said level of hemoglobin and said level of creatinine, in said physical computing device, to determine level of transfusion risk; c) applying said information regarding current or past history of disease of said subject, in said physical computing device, to determine level of comorbidity; d) applying said level of hemoglobin, said level of transfusion risk, and said level of comorbidity, in said physical computing device, to determine a patient care plan.

Claims

1. A method of providing treatment for a subject, said method comprising:

a) receiving a profile of said subject said profile comprising a level of hemoglobin of said subject and information regarding current or past history of disease of said subject; and

b) utilizing said level of hemoglobin to determine a level of anemia; and

c) utilizing said level of hemoglobin to determine a level of transfusion risk;

in said physical computing device; and

d) utilizing said information regarding current or past history of disease of said subject to determine a level of comorbidity; and

e) utilizing said level of anemia, said level of transfusion risk, and said level of comorbidity to create a preoperative patient care plan, wherein said preoperative patient care plan comprises one or more directives selected from the following;

administration of oral iron, intravenous iron, an erythropoietic medication, ferric carboxymaltose, iron sucrose, ascorbic acid, folate, vitamin B12, tranexamic acid, or desmopressin acetate;

preoperative dialysis, preoperative coagulation therapy, or preoperative autologous blood donation;

wherein said directives are to initiate treatment of said subject at least one week prior to a non-emergent surgery, wherein said preoperative patient care plan is included in a patient care plan; and

wherein said subject is treated in accordance with at least one of said directives of said preoperative patient care plan and wherein said patient care plan is configured to reduce a risk associated with the non-emergent surgery.

2. The method of claim 1, wherein said method further comprises receiving a type of non-emergent surgery information and red cell antibody information, wherein said method comprises:

f) utilizing said type of said non-emergent surgery information to determine a range of anticipated loss of blood volume;

g) utilizing said range of anticipated loss of blood volume and said level of comorbidity to determine a range of tolerable loss of blood volume;

h) utilizing said red cell antibody information to determine one or more compatible blood types; and

i) utilizing said range of anticipated loss of blood volume, said range of tolerable loss of blood volume, and said one or more compatible blood types to create directives for an in-hospital blood management or transfusion minimization care plan,

wherein said in-hospital blood management or transfusion minimization care plan is included in said patient care plan.

3. The method of claim 1, wherein said non-emergent surgery is an orthopedic surgery, a cardiovascular surgery, a genitourinary surgery, a gastrointestinal surgery, other vascular surgery, a gynecology surgery, a neurosurgery, an oncologic thoracic surgery, a high-risk caesarian delivery, or any combination thereof.

4. The method of claim 3, wherein said non-emergent surgery is said orthopedic surgery selected from the group consisting of primary or revision total knee replacement surgery that is single or bilateral, primary or revision partial knee replacement surgery that is single or bilateral, primary or revision total hip joint arthroplasty, and spine surgery;

said non-emergent surgery is said cardiovascular surgery selected from the group consisting of cardiac valve replacement, cardiac valve repair, coronary artery bypass surgery, coronary artery bypass surgery with cardiac valve repair or replacement, and aortic replacement surgery;

said non-emergent surgery is said genitourinary surgery selected from the group consisting of radical retropubic prostatectomy and cystectomy;

said non-emergent surgery is said gastrointestinal surgery, and said gastrointestinal surgery treats a cancer or an inflammatory bowel disease;

said non-emergent surgery is said vascular surgery for aneurysm repair;

said non-emergent surgery is said gynecology surgery selected from the group consisting of hysterectomy with or without bilateral salpingo-oophorectomy, tumor debulking, omentectomy, and lymph node sampling;

said non-emergent surgery is said neurosurgery selected from the group consisting of meningioma resection and surgery to correct vascular malformation;

or said non-emergent surgery is said oncologic thoracic surgery for removal of a lung tumor.

5. The method of claim 1, wherein said patient care plan comprises a directive for use of a transfusion product having a shelf age of less than 14 days.

6. The method of claim 1, wherein said level of transfusion risk of said subject is determined to be low, intermediate, high, or very high.

7. The method of claim 1, wherein said preoperative patient care plan comprises one or more directives selected from the following:

administration of epoetin, epoetin alfa, darbepoetin alfa, epoetin delta, PDpoetin, or methoxy polyethylene glycol-epoetin beta.

8. The method of claim 1, further comprising repeating steps (a)-(d) to provide a revised patient care plan prior to said non-emergent surgery.

9. The method of claim 8, wherein said revised profile further comprises revised weight, gender, revised age, revised date of non-emergent surgery, revised information regarding whether or not said non-emergent surgery is a repeat procedure, and/or revised information regarding whether or not said non-emergent surgery is a non-isolated procedure.

10. The method of claim 2, wherein said in-hospital blood management or said transfusion minimization comprises the directive that if said one or more comorbid conditions are present, then said in-hospital blood management or transfusion minimization care plan comprises providing said patient with a transfusion product that has a shelf age of less than 14 days.

11. The method of claim 1, wherein said method, following step e), comprises:

utilizing information regarding said subject after undergoing said non-emergent surgery, wherein said information regarding said subject after undergoing said non-emergent surgery comprises information regarding loss of blood volume during said non-emergent surgery, information regarding whether said subject had a transfusion during said non-emergent surgery, and information regarding adverse events; and

utilizing said information regarding said subject after undergoing said non-emergent surgery, said profile, said level of transfusion risk, said level of comorbidity, said preoperative patient care plan, and said in-hospital transfusion minimization care plan to create a patient outcome report.

12. The method of claim 2, wherein said method further comprises utilizing said level of hemoglobin to determine a level of bleeding risk.

13. The method of claim 12, wherein said level of bleeding risk is determined to be high if said subject is taking one or more procoagulant medications.

14. The method of claim 13, wherein if said level of bleeding risk is high, said one or more directives comprises obtaining information from one or more laboratory tests selected from the group consisting of a screening coagulation panel and a special coagulation test.

15. The method of claim 12, wherein if said subject is anemic then said one or more directives comprises obtaining a determination of one or more laboratory tests selected from the group consisting of an iron assessment panel, a complete blood count, a reticulocyte count, a hemoglobin test, a vitamin B12 test, a folate test, and a C reactive protein assay.

16. The method of claim 12, wherein said one or more directives comprises obtaining information from a second test panel, wherein said second test panel comprises:

one or more laboratory tests selected from the group consisting of a red cell antibody identification test, a direct antiglobulin test, an indirect antiglobulin test, and a blood typing test.

17. The method of claim 16, wherein if the one or more red cell antibodies are present, then said patient care plan comprises providing a directive that blood components compatible with the one or more red cell antibodies are available for transfusion during said non-emergent surgery.

18. The method of claim 1, wherein said method further comprises:

utilizing said information regarding current or past history of disease to determine a level of renal risk, wherein if said information regarding current or past history of disease comprises current or past history of renal disease or current or past history of diabetes, then said level of renal risk is high; and

wherein if said level of renal risk is high, then one or more directives comprises utilizing a creatinine test with calculated glomerular filtration rate or a blood urea nitrogen test.

19. The method of claim 18, wherein if said level of creatinine is more than 2 mg/dL, then said patient care plan comprises dialysis.

20. The method of claim 1, further comprising outputting a patient satisfaction outcome report, a hospital satisfaction outcome report, an adverse event outcome report, or a surgical outcome-specific report comprising said preoperative patient care plan.

21. The method of claim 1, wherein said profile further comprises a level of blood health index of said subject, and wherein said level of blood health index is determined from one or more laboratory tests selected from the group consisting of a creatinine test, a glomerular filtration rate test, a vitamin B12 test, and a folate test.

22. The method of claim 21, wherein said level of blood health index comprises one or more of level of serum iron, level of % iron saturation, level of ferritin, level of C reactive protein, mean corpuscular volume, mean corpuscular hemoglobin, level of vitamin B12, or level of folate.

23. The method of claim 21, wherein said method further comprises:

utilizing said profile and said level of blood health index to determine a level of renal risk, wherein if said level of renal risk is high, then said patient care plan for treating said high level of renal risk comprises one or more directives selected from the following;

administration of oral iron, intravenous iron, ferric carboxymaltose, iron sucrose, iron dextran, erythropoietin, folate, vitamin B12, epoetin, epoetin alfa, darbepoetin alfa, epoetin delta, PDpoetin, or methoxy polyethylene glycol-epoetin beta.

24. The method of claim 1, wherein said profile comprises a level of creatinine of said subject, wherein said method comprises applying said level of creatinine to determine said level of transfusion risk.

25. The method of claim 24, wherein said profile comprises a level of creatinine if said patient has been determined to have low hemoglobin.

26. The method of claim 1, wherein said method comprises comparing said level of hemoglobin to a predetermined value of hemoglobin indicative of anemia.

27. The method of claim 26, wherein said patient is determined to have anemia.

28. The method of claim 27, wherein said patient is determined to have chronic anemia.

29. The method of claim 27, wherein if said anemia is profound, then said directives comprise consideration to cancel surgery.

30. The method of claim 1, wherein said method comprises applying surgical demographics and clinical information to identify risks which may be mitigated prior to surgery.

31. The method of claim 1, wherein the subject has a chronic disease selected from the group consisting of a chronic heart failure, an inflammatory gastrointestinal disease, a rheumatologic inflammatory disease, a chronic viral disease, a chronic inflammatory state, a gynecological state, and a post-surgical state;

wherein said chronic inflammatory state is selected from the group consisting of diabetes, chronic renal disease, and obesity;

wherein said chronic viral disease is selected from the group consisting of hepatitis C infection, hepatitis B infection, and HIV infection; and

wherein said gynecological state is pregnancy.

32. The method of claim 1, wherein the patient care plan is communicated to the subject, a surgeon, and/or a hospital.

33. The method of claim 1, wherein said patient care plan comprises a surgical patient care plan comprising one or more directives selected from the group consisting of use of a cell saver, acute normovolemic hemodilution (ANH), administration of tranexamic acid (TXA), and cautious use of hemodilution for patients.

34. The method of claim 2, wherein said patient care plan comprises a surgical patient care plan comprising one or more directives selected from the group consisting of use of a cell saver, acute normovolemic hemodilution (ANH), administration of tranexamic acid (TXA), and cautious use of hemodilution for patients.

35. The method of claim 1, wherein said patient care plan comprises an in-hospital and post-surgical patient care plan comprising one or more directives selected from the group consisting of TXA, pediatric blood tubes, minimization of lab draws, administration of oral iron, administration of intravenous iron, and administration of erythropoietin-stimulating agents.

36. The method of claim 2, wherein said patient care plan comprises an in-hospital and post-surgical patient care plan comprising one or more directives selected from the group consisting of administration of TXA, pediatric blood tubes, minimization of lab draws, administration of oral iron, administration of intravenous iron, and administration of erythropoietin-stimulating agents.

37. The method of claim 34, wherein said patient care plan comprises an in-hospital and post-surgical patient care plan comprising one or more directives selected from the group consisting of administration of TXA, pediatric blood tubes, minimization of lab draws, administration of oral iron, administration of intravenous iron, and administration of erythropoietin-stimulating agents.

38. The method of claim 1, wherein said patient care plan comprises a post-discharge patient care plan comprising one or more postoperative directives selected from the group consisting of administration of oral iron, administration of intravenous iron, and administration of erythropoietin-stimulating agents.

39. The method of claim 2, wherein said patient care plan comprises a post-discharge patient care plan comprising one or more postoperative directives selected from the group consisting of administration of oral iron, administration of intravenous iron, and administration of erythropoietin-stimulating agents.

40. The method of claim 34, wherein said patient care plan comprises a post-discharge patient care plan comprising one or more postoperative directives selected from the group consisting of administration of oral iron, administration of intravenous iron, and administration of erythropoietin-stimulating agents.

41. The method of claim 36, wherein said patient care plan comprises a post-discharge patient care plan comprising one or more postoperative directives selected from the group consisting of administration of oral iron, administration of intravenous iron, and administration of erythropoietin-stimulating agents.

42. The method of claim 1, wherein said patient care plan comprises administration of erythropoietin.

43. The method of claim 1, wherein said information regarding current or past history of disease comprises past history of cardiovascular disease, cerebrovascular disease, pulmonary disease, renal disease, cancer, autoimmune disease, gastrointestinal disease, pregnancy, bleeding disorder, inflammatory disease, active infection, blood clotting disorder, or use of over the counter or prescribed medications.

44. The method of claim 1, wherein said patient care plan comprises two, three, four, five, six, seven, eight, nine, ten, or more of said directives.

45. The method of claim 1, wherein said risk is selected from the group consisting of a transfusion risk, a comorbidity risk, and a surgical risk.

46. A method of preparing a subject for a non-emergent surgery, said method comprising:

a) obtaining a determination of a level of anemia and a level of transfusion risk of said subject, each of which has been determined using a level of hemoglobin of said subject; and

b) obtaining a determination of a level of comorbidity of said subject, which has been determined using information regarding current or past history of disease of said subject; and

c) obtaining a preoperative patient care plan for said subject comprising one or more directives selected from the following;

administration of oral iron, intravenous iron, an erythropoietic medication, ferric carboxymaltose, iron sucrose, ascorbic acid, folate, vitamin B12, tranexamic acid, or desmopressin acetate;

preoperative dialysis, preoperative coagulation therapy, or preoperative autologous blood donation;

which has been created using said level of anemia, said level of transfusion risk, and said level of comorbidity, wherein said preoperative patient care plan is included in a patient care plan; and

d) following step (c), treating said subject in accordance with at least one of said directives of said preoperative patient care plan at least one week prior to said non-emergent surgery,

wherein a risk associated with the non-emergent surgery is reduced.

47. The method of claim 46, wherein said patient care plan comprises an in-hospital blood management or transfusion minimization care plan comprising:

(a1) obtaining a determination of a range of anticipated loss of blood volume for said subject, which was determined using a type of non-emergent surgery information of said subject;

or

(a2) obtaining a determination of a range of tolerable loss of blood volume for said subject, which was determined using said range of anticipated loss of blood volume and a level of comorbidity.

48. The method of claim 46, further comprising performing said non-emergent surgery on said subject, wherein said non-emergent surgery is an orthopedic surgery, a cardiovascular surgery, a genitourinary surgery, a gastrointestinal surgery, other vascular surgery, a gynecology surgery, a neurosurgery, an oncologic thoracic surgery, a high-risk caesarian delivery, or any combination thereof.

49. The method of claim 48, wherein said non-emergent surgery is said orthopedic surgery selected from the group consisting of primary or revision total knee replacement surgery that is single or bilateral, primary or revision partial knee replacement surgery that is single or bilateral, primary or revision total hip joint arthroplasty, and spine surgery;

said non-emergent surgery is said cardiovascular surgery selected from the group consisting of cardiac valve replacement, cardiac valve repair, coronary artery bypass surgery, coronary artery bypass surgery with cardiac valve repair or replacement, and aortic replacement surgery;

said non-emergent surgery is said genitourinary surgery selected from the group consisting of radical retropubic prostatectomy and cystectomy;

said non-emergent surgery is said gastrointestinal surgery, and said gastrointestinal surgery treats a cancer or an inflammatory bowel disease;

said non-emergent surgery is said vascular surgery for aneurysm repair;

said non-emergent surgery is said gynecology surgery selected from the group consisting of hysterectomy with or without bilateral salpingo-oophorectomy, tumor debulking, omentectomy, and lymph node sampling;

said non-emergent surgery is said neurosurgery selected from the group consisting of meningioma resection and surgery to correct vascular malformation;

or said non-emergent surgery is said oncologic thoracic surgery for removal of a lung tumor.

50. The method of claim 46, wherein step (a) further comprises obtaining a determination of a level of transfusion risk of said subject, wherein said level of transfusion risk is low, intermediate, high, or very high.

51. The method of claim 50, wherein step (c) further comprises, as part of the patient care plan, the following:

if said level of transfusion risk is low or intermediate and said one or more comorbid conditions are not present, then said preoperative patient care plan comprises one or more of administration of oral iron, ascorbic acid, or a multivitamin.

52. The method of claim 50, wherein step (c) further comprises, as part of the patient care plan, the following:

if said one or more comorbid conditions are present, then said preoperative patient care plan comprises one or more of administration of an erythropoietic medication, intravenous iron, oral iron, tranexamic acid, or desmopressin acetate;

preoperative dialysis, preoperative coagulation therapy, or preoperative autologous blood donation.

53. The method of claim 50, wherein step (c) further comprises, as part of the patient care plan, the following:

if said level of transfusion risk is high or very high, then said patient care plan comprises administration of intravenous iron, erythropoietic stimulating factor, or tranexamic acid;

use of a cell saver, preoperative autologous blood donation, postoperative iron, or use of pediatric blood tubes for blood draws.

54. The method of claim 46, wherein step (c) further comprises, as part of the one or more directives and prior to step (e), administration of oral iron, intravenous iron, ferric carboxymaltose, iron sucrose, iron dextran, ascorbic acid, erythropoietin, folate, vitamin B12, epoetin, epoetin alfa, darbepoetin alfa, epoetin delta, PDpoetin, or methoxy polyethylene glycol-epoetin beta.

55. The method of claim 46, further comprising repeating steps (a) and (b) to provide a revised patient care plan prior to step (e).

56. The method of claim 55, wherein said revised patient care plan has been created using a revised weight, gender, revised age, revised date of non-emergent surgery, revised level of creatinine, revised information regarding whether or not said non-emergent surgery is a repeat procedure, and/or revised information regarding whether or not said non-emergent surgery is a non-isolated procedure.

57. The method of claim 47, wherein said in-hospital blood management or said transfusion minimization care plan comprises the directive that if said one or more comorbid conditions are present, then said in-hospital blood management or transfusion minimization care plan comprises providing said patient with a transfusion product having a shelf age of less than 14 days.

58. The method of claim 47, wherein said method further comprises obtaining a patient outcome report, which was produced using information regarding said subject after undergoing said non-emergent surgery, said level of transfusion risk, said level of comorbidity, said preoperative patient care plan, and said in-hospital blood management or transfusion minimization care plan, and wherein said information regarding said subject after undergoing said non-emergent surgery comprises information regarding loss of blood volume during said non-emergent surgery, information regarding whether said subject had a transfusion during said non-emergent surgery, and information regarding adverse events.

59. The method of claim 58, wherein said method further comprises obtaining a determination of a bleeding risk, wherein said bleeding risk was determined using said level of hemoglobin and said level of transfusion risk.

60. The method of claim 59, wherein said level of bleeding risk is high if said subject is taking one or more procoagulant medications.

61. The method of claim 60, wherein if said determination of level of bleeding risk is high, said one or more directives comprises obtaining information from one or more laboratory tests selected from the group consisting of a screening coagulation panel and a special coagulation test.

62. The method of claim 61, wherein if said subject is anemic, then said one or more directives comprises obtaining a determination of one or more laboratory tests from the group consisting of an iron assessment panel, a complete blood count, a hemoglobin test, a vitamin B12 test, a folate test, and a C reactive protein assay.

63. The method of claim 47, wherein said patient care plan further comprises a directive for obtaining a determination of results of a second test panel, wherein said second test panel comprises obtaining a determination of one or more laboratory tests selected from the group consisting of a red cell antibody identification test, a direct antiglobulin test, an indirect antiglobulin test, and a blood typing test.

64. The method of claim 63, wherein if one or more of the red cell antibodies are present, said patient care plan comprises, as part of the one or more directives, that blood components compatible with the one or more red cell antibodies should be available for transfusion during said non-emergent surgery.

65. The method of claim 46, wherein said patient care plan comprises a directive for a determination of a level of renal risk based upon information regarding current or past history of disease in the subject, wherein if said information regarding current or past history of disease comprises current or past history of renal disease or current or past history of diabetes, then said level of renal risk is high, wherein if said level of renal risk is high, said method comprises obtaining a result of a creatinine test with calculated glomerular filtration rate or a blood urea nitrogen test.

66. The method of claim 65, wherein if said level of creatinine is more than 2 mg/dL, then said patient care plan comprises a directive for dialysis.

67. The method of claim 46, further comprising obtaining a patient satisfaction outcome report, a hospital satisfaction outcome report, an adverse event outcome report, or a surgical outcome-specific report comprising said preoperative patient care plan or said revised patient care plan.

68. The method of claim 46, wherein said patient care plan comprises a directive for obtaining a determination of a level of blood health index of said subject, which was determined from one or more laboratory tests selected from the group consisting of a creatinine test, a glomerular filtration rate test, a vitamin B12 test, and a folate test.

69. The method of claim 68, wherein said patient care plan comprises a directive for obtaining one or more of a level of serum iron, level of % of iron saturation, level of ferritin, level of C reactive protein, mean corpuscular volume, mean corpuscular hemoglobin, level of vitamin B12, or level of folate.

70. The method of claim 69, wherein if said renal risk is high said patient care plan comprises a directive for administration of oral iron, intravenous iron, ferric carboxymaltose, iron sucrose, iron dextran, erythropoietin, folate, vitamin B12, epoetin, epoetin alfa, darbepoetin alfa, epoetin delta, PDpoetin, or methoxy polyethylene glycol-epoetin beta.

71. The method of claim 46, wherein said patient care plan comprises a directive for obtaining a determination of a level of transfusion risk determined using a level of creatinine of said subject.

72. The method of claim 71, wherein said level of creatinine was determined in a patient with a low level of hemoglobin.

73. The method of claim 71, wherein said level of hemoglobin was determined using a predetermined value of hemoglobin indicative of anemia.

74. The method of claim 71, wherein said patient was determined to have anemia.

75. The method of claim 74, wherein said patient was determined to have chronic anemia.

76. The method of claim 74, wherein if said anemia was determined to be profound, then said patient care plan comprises a directive for consideration to cancel surgery.

77. The method of claim 46, wherein said patient care plan comprises a directive for obtaining a determination of surgical demographics and clinical information to identify risks which may be mitigated prior to surgery.

78. The method of claim 46, wherein the subject has a chronic disease selected from the group consisting of a chronic heart failure, an inflammatory gastrointestinal disease, a rheumatologic inflammatory disease, a chronic viral disease, a chronic inflammatory state, a gynecological state, and a post-surgical state;

wherein said chronic inflammatory state is selected from the group consisting of diabetes, chronic renal disease, and obesity;

wherein said chronic viral disease is selected from the group consisting of hepatitis C infection, hepatitis B infection, and HIV infection; and

wherein said gynecological state is pregnancy.

79. The method of claim 46, wherein the patient care plan is communicated to the subject, a surgeon, and/or a hospital.

80. The method of claim 46, wherein said patient care plan comprises directives for treating said subject during surgery selected from (i) use of a cell saver, (ii) acute normovolemic hemodilution (ANH), (iii) administration of tranexamic acid (TXA), and (iv) cautious use of hemodilution for patients that are small.

81. The method of claim 47, wherein said patient care plan comprises directives for treating said subject during surgery selected from (i) use of a cell saver, (ii) acute normovolemic hemodilution (ANH), (iii) administration of tranexamic acid (TXA), and (iv) cautious use of hemodilution for patients that are small.

82. The method of claim 46, wherein said patient care plan comprises directives for treating said subject said subject following surgery and prior to discharge from a hospital selected from (i) administration of TXA, (ii) minimization of lab draws, (iii) administration of oral iron, (iv) administration of intravenous iron, (v) administration of erythropoietin-stimulating agents, and (vi) use of pediatric blood tubes.

83. The method of claim 47, wherein said patient care plan comprises directives for treating said subject said subject following surgery and prior to discharge from a hospital selected from (i) administration of TXA, (ii) minimization of lab draws, (iii) administration of oral iron, (iv) administration of intravenous iron, (v) administration of erythropoietin-stimulating agents, and (vi) use of pediatric blood tubes.

84. The method of claim 81, wherein said patient care plan comprises directives for treating said subject said subject following surgery and prior to discharge from a hospital selected from (i) administration of TXA, (ii) minimization of lab draws, (iii) administration of oral iron, (iv) administration of intravenous iron, (v) administration of erythropoietin-stimulating agents, and (vi) use of pediatric blood tubes.

85. The method of claim 46, wherein said patient care plan comprises one or more postoperative directives selected from (i) administration of oral iron, (ii) administration of intravenous iron, and (iii) administration of erythropoietin-stimulating agents, wherein said directives are for treating said subject following discharge from a hospital.

86. The method of claim 47, wherein said patient care plan comprises one or more postoperative directives selected from (i) administration of oral iron, (ii) administration of intravenous iron, and (iii) administration of erythropoietin-stimulating agents, wherein said directives are for treating said subject following discharge from a hospital.

87. The method of claim 81, wherein said patient care plan comprises one or more postoperative directives selected from (i) administration of oral iron, (ii) administration of administration of intravenous iron, and (iii) administration of erythropoietin-stimulating agents, wherein said directives are for treating said subject following discharge from a hospital.

88. The method of claim 83, wherein said patient care plan comprises one or more postoperative directives selected from (i) administration of oral iron, (ii) administration of intravenous iron, and (iii) administration of erythropoietin-stimulating agents, wherein said directives are for treating said subject following discharge from a hospital.

89. The method of claim 46, wherein said patient care plan comprises a directive for administering erythropoietin.

90. The method of claim 46, wherein said information regarding current or past history of disease comprises past history of cardiovascular disease, cerebrovascular disease, pulmonary disease, renal disease, cancer, autoimmune disease, gastrointestinal disease, pregnancy, bleeding disorder, inflammatory disease, active infection, blood clotting disorder, or use of over the counter or prescribed medications.

91. The method of claim 46, wherein said patient care plan comprises two, three, four, five, six, seven, eight, nine, ten, or more of said directives.