Post-Operation Triggers in High Cardiac Risk Patients

Eligibility Details: Inclusion Criteria: - Males and females older than 18 years of age who have postoperative Hb < 10gm/dl within 15 days after the index operation - Patients who undergo an operation in either one of the three following categories: - Veterans who undergo PAD - related operations including but not limited to the following: - aortobifemoral or aortobiiliac bypass - open abdominal aortic aneurysm repair with simultaneous repair of aortoiliac occlusive disease - visceral bypass - iliofemoral bypass - femoral bypass or endarterectomy - infrainguinal bypass - thromboembolectomy - supra-aortic trunk bypass or endarterectomy - carotid endarterectomy - major lower extremity amputations (transfemoral, through the knee, or transtibial) - Veterans with past medical history of ischemic stroke or IHD or PAD who undergo the following general surgery procedures, defined as: - known prior MI - ECG findings consistent with prior MI - prior percutaneous coronary intervention - prior coronary artery bypass surgery - history of angina for which the patient is currently receiving treatment - stress test indicating myocardial ischemia - who undergo the following General Surgery operations: - Open cholecystectomy or other complex biliary reconstruction - such as open common bile duct exploration for stones - reconstruction as part of oncologic operations such as palliative pancreatic cancer procedures) - small bowel resection - pancreatectomy - colon resection - rectal resection - splenectomy - transhiatal esophagectomy - liver resection - gastric resection - open ventral hernia repair - Colostomies (reversals and takedowns) - Veterans with past medical history of ischemic stroke or IHD or PAD who undergo the following Vascular Surgery operations: - Open aneurysm repair, including but not limited to: - carotid - subclavian - abdominal aortic - iliac - femoral - popliteal aneurysms - and complex endovascular aneurysm repair, defined as: - fenestrated endograft - or endograft with need for iliac conduit - or endovascular aneurysm repair with simultaneous femoral artery reconstruction or bypass - Patients undergoing the above procedures will be included in the study regardless of their preoperative Hb level, and regardless of preoperative or intraoperative transfusion they might have received. Exclusion Criteria: - Veteran unable to consent - Veteran unwilling to follow protocol (such as Jehovah's witnesses) - Veteran with known history of hereditary anemias such as Thalassemia or Sickle cell disease - Veteran with known history of hereditary bleeding disorders, such as factor VIII or factor IX deficiency - Veteran with prior history of adverse reaction to blood administration, such as fever, rash, or hemolysis - Veteran does not speak or understand English - Veteran hemodynamically unstable or in cardiogenic shock - Veteran participating in another interventional trial whose objective is to evaluate the effect of transfusion on outcomes - Pregnancy in female Veterans - Veteran is a prisoner or in custody of law enforcement - Prior randomization in the CSP#599