The principles of Patient Blood Management apply to all patients who may need transfusion.
In elective surgery the principles of PBM have been described as the so called '3 pillars' namely:
- Optimizing the patient's own blood (e.g. pre-operative optimization of haemoglobin and haemostasis)
- Minimising surgical blood loss
- Optimizing the patient's physiological reserve in relation to anaemia (including use of restrictive transfusion triggers)
However the key principles of PBM apply not just to surgery but to all patients who may need a blood transfusion (medical, obstetric, paediatrics), and to both elective and emergency clinical settings.
The overall use of red cells is decreasing in many countries but large audits still show much inappropriate use. Greater scrutiny is also needed in relation to appropriate use of platelet and plasma transfusion.
Accordingly, PBM covers all aspects of decision-making in transfusion therapy, including patient evaluation and clinical management with use of appropriate indications and triggers, minimization of blood loss and optimization of the patient's own red cell mass. By reducing the need for allogeneic blood transfusions and minimising risks and unnecessary work, PBM can also reduce health-care costs.
A pragmatic approach to embedding patient blood management in a tertiary hospital.
This figure shows blood product use per admission (all admissions) between 2008 to 2011 (p<0.001 for RBC usage per admission).
The experience of one regional programme: even while hospital activity increased, transfusions rates reduced over time. Patient admissions increased by 22%.
References
- Patient blood management. Goodnough LT & Shander A.Anesthesiology 2012; 116:1367-76.
- Transfusing blood safely and appropriately. Murphy MF et al.BMJ 2013;347 :f4303
- Restrictive blood transfusion practices are associated with improved patient outcomes. Goodnough LT et al.Transfusion 2014; 54: 2753–2759.
- Increased hospital costs associated with red blood cell transfusion. Trentino KM et al.Transfusion 2015; 55: 1082–1089.
- A pragmatic approach to embedding patient blood management in a tertiary hospital. Leahy MF et al.Transfusion 2014;54: 1133-45.
- Improving red cell transfusion in the elective surgical setting: an improvement collaborative with evaluation. Harrison BT et al.Vox Sanguinis 2015; 108: 393–402.
The authors
Erica Wood
Past President (2022-2024)
Erica Wood is an ISBT Board member and a member of ISBT working parties for clinical practice, haemovigilance, and transfusion-transmitted infectious diseases. From 2010-2014 she was ISBT regional director for the Western Pacific region. Erica is head of the Transfusion Research Unit in the Department of Epidemiology and Preventive Medicine at Monash University in Melbourne, Australia. She is a consultant haematologist at Monash Health and holds an honorary appointment at the Peter MacCallum Cancer Centre.
Erica is president of the International Haemovigilance Network, past-president of the Australian and New Zealand Society of Blood Transfusion, and a member of the World Health Organization Expert Advisory Panel in Transfusion Medicine. Erica has served as Chief Examiner (Haematology) for the Royal College of Pathologists of Australasia and chair of the Joint Specialist Advisory Committee in Haematology.
She is a member of the Victorian Blood Matters program advisory committee and the expert group of its Serious Transfusion Incident Reporting (STIR) haemovigilance program. In 2013, Erica was awarded a Churchill Fellowship to support her practice and research in patient blood management.
- Twitter:
- @erica_m_wood
Shubha Allard
Shubha Allard MD FRCP FRCPath. Consultant Haematologist, NHS Blood and Transplant. RCPath Clinical Director for Publishing & Engagement actively promoting the role and expertise of various pathology specialities in patient care together with wider public awareness. Member of ISBT Clinical Transfusion Working Party (previous Co Chair); member of Steering group for update of WHO and ISBT Clinical Use of Blood Educational modules; past ISBT Regional Director for Europe.