Patient blood management (PBM) is the timely application of evidence-based medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis and minimise blood loss in an effort to improve patient outcomes.
The Austrian benchmark study of blood use in adult patients undergoing elective surgery demonstrated three main predictors for red blood cell transfusions:
- preoperative anaemia
- volume of surgical blood loss, and
- failure to adopt a more restrictive threshold for transfusion.
Strategies to address these risks are referred to as the three pillars of PBM:
- optimisation of blood volume and red cell mass
- minimisation of blood loss, and
- optimisation of the patient’s tolerance of anaemia.
PBM uses a multidisciplinary team approach incorporating individually tailored proactive treatment to conserve a patient’s own blood.
Techniques may involve the use of pharmaceutical agents and medical devices to reduce the need for allogeneic blood transfusion.
An increasing focus on PBM has been driven by a number of factors including:
- the risks associated with blood transfusion - with increasing evidence of increased length of stay and higher risk of morbidity and mortality
- rising costs, both direct and indirect, associated with provision and transfusion of allogeneic blood, and
- challenges of maintaining an adequate blood supply in the face of increased demand due to ageing population.
Within the surgical setting, adopting the principles of patient blood management begins when an operation is scheduled and continues right through to patient recovery, incorporating preoperative, intraoperative and postoperative measures.
Principles and strategies used for PBM are also relevant to non-surgical patients.
These strategies are advancing and becoming a key area for improvement within the health sector in Australia and internationally, with increasing evidence their use results in:
- increased patient satisfaction
- decrease in the need for transfusion
- improved patient outcomes, and
- healthcare cost savings.