What nurses know about blood health: conversations that save lives
What nurses and blood health professionals see that others miss
Nurses are often the first to notice something is wrong, the most trusted person in the room when something needs explaining, and the professional most likely to connect the dots between a patient’s daily life and their clinical outcomes. They are not just caregivers. They are translators, advocates, and often the decisive voice in the room when blood health is at stake.
Sherri Ozawa has spent more than three decades working at the intersection of nursing and blood health. She is direct about what makes nursing’s role in blood health distinctive, and why it cannot be replicated by any other professional on the care team. Her work has shown her that the relationship between nurses and blood health outcomes is built one conversation at a time.
Patients share things with nurses that they do not share with their physicians. Financial pressures. The reality of what their diet actually looks like. The fact that they stopped taking their iron supplement because the side effects were difficult and they did not want to complain. Nurses are trained to bring those things to the surface, to understand the practical realities of a patient’s life and work with them, not around them.
Sherri describes this as translational work. A patient leaves a consultation with a surgeon or anaesthesiologist feeling overwhelmed or uncertain. The nurse is the person who asks how it went, listens to what was heard rather than what was said, and finds a way to make the clinical guidance real and actionable.
When patients feel like partners in their own health, she notes, their outcomes are clinically better. That is not a soft observation. It is reflected in the data, and it is the quiet engine behind everything patient blood management tries to do. Nurses and blood health, she argues, belong in the same sentence at every stage of a patient’s journey, not just at the moments where intervention happens, but at the moments where conversation does. The nurses and blood health relationship is not just nice to have. It is, increasingly, the difference between outcomes that work and outcomes that fail.
Nurses are often the first to notice, the first to translate, and the first to advocate.
Blood health starts long before the operating room
Sarah Walbolt is a nurse whose career has taken her from gastroenterology into operating room nursing, where she witnessed both emergency deliveries and hemorrhage outcomes, and into her current role as a patient blood management programme manager. Part of her work today is investigating poor outcomes in surgical and maternal care: asking what could have been different, and how the next patient can be protected.
She has developed a simple reframe that changes how patients hear her role. Patient blood management said backwards is managing the blood of you the patient. That one shift in language, she says, immediately makes people understand what is at stake and why it matters personally. It turns a phrase that sounds institutional into one that sounds protective.
In surgical populations, pre-operative anaemia is not an edge case. Sarah has found that 30 to 40 percent of patients arriving for elective surgery present with lower haemoglobin than is ideal, often because no one checked earlier, or because fatigue and low energy had quietly become their normal. The World Health Organization identifies anaemia as one of the most common preventable conditions globally, a clinical fact that nursing teams encounter routinely, especially in pre-operative care.
The window to address this is not at the point when a surgeon is already asking for options. It is weeks earlier, when there is still time to support the patient’s own blood health through nutrition, supplementation, or treatment.
That is where nursing has a particular role, because it is often nurses who maintain the ongoing relationship with patients through that preparatory period. The window is open. Someone has to use it. The connection between nurses and blood health outcomes in pre-operative care is not theoretical. It is built one conversation at a time.
Sarah’s understanding of this was shaped early. In her twenties, she lost a close friend, Naomi, to a preeclampsia-related maternal death. They were in a city with choices, Sarah recalls, and had they known the seriousness of Naomi’s risk, they would have taken her to a hospital with the capability to handle that kind of emergency. The delay in care was the delay of not knowing. It is, Sarah says, why she does the work she does today.
Every pregnant person deserves to know their blood health going into delivery — calmly, in advance, with information.
What every pregnant person should know about blood health
Becky Rock is a nurse with a patient blood management background who has worked extensively in maternal health, and currently serves as President-Elect of the Society for the Advancement of Patient Blood Management (SABM). She describes a gap she sees repeatedly in her work on nurses and blood health: the careful preparation most families put into welcoming a baby, and the near-complete absence of any conversation about blood health or what to do if things do not go as planned.
Menstrual health, she says, is like the foundation of a house. If it is erratic, irregular, or abnormal, everything built on top of it, including something as important as pregnancy, is a struggle. More than thirty percent of women experience heavy menstrual periods, and yet it is something most people do not discuss, even with their own doctors.
Iron, she adds, is the unsung hero of pregnancy. The signs of iron deficiency are easy to dismiss as the normal exhaustion of modern life or early motherhood: falling asleep at red lights, cravings for ice or cardboard, an unshakable brain fog. These are not quirks. They are physical signals the body is sending about something measurable and treatable, and they are part of why the role of nutrition in blood health matters at every stage of life.
Every pregnant person, Becky says, should know their blood health going into delivery. Not to alarm them, but because decisions about iron infusion, clotting management, or transfusion should not be made in the middle of a crisis. They should be made in advance, calmly, with information, as part of a birth plan that accounts for both the best outcome and the unexpected one.
Her advice is direct. If you are thinking about whether you want an epidural, you should also be thinking about your blood. Ask about your iron levels. Understand your options. Give your care team the information they need to act quickly if they need to.
Did you know?
- Pre-operative anaemia affects 30 to 40 percent of patients scheduled for elective surgery, often without any prior diagnosis.
- More than 30 percent of women experience heavy menstrual periods — yet most never discuss it with a healthcare provider.
- During a routine delivery, a mother is expected to lose 500 to 1,000 millilitres of blood. It is not uncommon to lose two to four units.
- A patient’s haemoglobin level is as measurable and meaningful as their oxygen saturation — yet far fewer people know what their number is.
- Iron deficiency can be present for years before it is formally diagnosed, because the body gradually adapts to lower levels.
Your own blood is the safest blood
Sarah returns to a practical point that she believes more patients need to hear. During delivery, a mother is expected to lose 500 to 1,000 millilitres of blood. It is not uncommon to lose two to four units. She has seen few surgeries (hip replacements, spinal operations, hysterectomies) that come close to that level of blood loss. Delivery, she says, is one of the riskiest moments in a woman’s life when it comes to her blood.
There is a procedure designed for exactly this moment. Cell salvage captures a patient’s blood as it is lost, cleans it, filters it, and returns it to her. It is the best blood the patient can receive: her own. Professional clinical guidance from major anaesthesiology and obstetric bodies recommends it. And yet many hospitals that have cell salvage capability do not use it in labour and delivery.
The reasons are often historical, Sarah explains. There was once a concern that amniotic fluid could contaminate the blood, an idea that has been largely disproven by modern research. The result is that a tool designed to save lives sits unused in wards that could benefit from it most. As a patient, knowing whether cell salvage is part of your hospital’s hemorrhage plan, and asking for it if it is not, is one of the most powerful pieces of advocacy you can do for yourself. This is exactly the kind of advocacy nurses and blood health specialists hope every patient will feel empowered to bring into the conversation.
In other words
Patient blood management: a clinical approach that optimises a patient’s own blood health before, during, and after any medical procedure, reducing the need for transfusion and improving outcomes. Nurses play a central role at every stage of that journey — from the initial conversation about iron levels, through the preparation for surgery or delivery, to the follow-up care that ensures a full recovery.
Cell salvage: a technique that recovers a patient’s own blood during surgery or delivery, cleans and filters it, and returns it to the patient. Recommended by major anaesthesiology and obstetric societies, but still not used in many labour and delivery settings where it could save lives.
Questions worth asking your healthcare provider
Sarah’s patient empowerment questions — worth printing, bringing to an appointment, or adding to your birth plan:
- What can I do now to protect my blood health before my delivery or surgery?
- What do you do to protect my blood health during my delivery or procedure, and in the postpartum period?
- What is your hemorrhage plan? Is cell salvage a part of it? If not, why not?
- Will my blood count and iron status be monitored six to eight weeks after delivery to ensure a full recovery?
- Given my medical history, are there specific risks I should be aware of, and what can we plan for now?
The vision: nurses and blood health at the centre of every conversation
Sherri Ozawa says that if she could change one thing about how blood health is approached globally, it would be that patients and providers bring it up as routinely as they raise heart health. Not just when something is wrong. From the very first visit. Doctor, nurse, whoever is taking care of me, let us talk about my blood health.
That is not a distant ambition. It is a shift in habit. And nurses are the professionals best placed to make it happen, because they are the ones already having the conversations that matter most. The work is not to teach nurses something new. It is to recognise what they already do, support them to do it at scale, and give patients permission to listen. The future of nurses and blood health rests on this recognition.
This is what International Nurses Day 2026 is really about. Not applause, but acknowledgement. Not gratitude alone, but the recognition that empowered, knowledgeable, trusted nurses are the single most effective lever healthcare has for improving blood health outcomes for mothers, for surgical patients, for anyone navigating a system that can still feel overwhelming when they need it most. When nurses and blood health are at the centre of the conversation rather than the edges, more patients get the care they need at the time they need it.
Further Reading
For a deeper look at how patient blood management works across surgical and maternal settings, Blood Works: An Owner’s Guide offers accessible clinical context for both professionals and patients — including chapters on maternal blood health, iron deficiency, and the role of nursing in modern PBM practice.
Know what to ask. Know what to expect.
Disclaimer:
This information is educational, not medical advice. Always talk to your doctor before making changes to your health care.