Blood transfusion is often considered to first-line treatment for the management of anemia and/or blood loss. However, there is now much evidence to support that both of these conditions can be effectively treated without resorting to allogenic blood through management and conservation of the patient’s own blood. This is the concept of patient blood management (PBM) that takes a holistic, multi-disciplinary approach to caring for a patient’s hematopoietic system to ensure the best possible outcomes. (1)
The World Health Organization (WHO) defines PBM as a “patient-focused, evidence-based and systematic approach for optimising the management of patients and transfusion of blood products to ensure high quality and effective patient care”. (2) PBM was endorsed by the World Health Assembly Resolution WHA63.12 in 2010, urging Member States that “before surgery every reasonable measure should be taken to optimise the patient’s own blood volume, to minimize the patient’s blood loss and to harness and optimize the patient-specific physiological tolerance of anaemia”. (3) These are the three pillars of PBM.
Key components of effective PBM programs as outlined by Cliff Sullivan and John D. Roback include:
While numerous studies support that PBM reduces adverse outcomes due to anemia, blood loss and transfusion, improves patient morbidity and mortality, and is cost-effective, implementation of PBM has been slow. (5) Barriers include commitment of time and staff, the development of new standard operating procedures, the reluctance to adopt new guidelines, and the lack of appropriate systems to monitor outcomes based on changes implemented as part of the PBM. (6)
Guidelines providing simple, cost-effective, best-practice, feasible, and evidence-based recommendations to enable hospitals to reduce both anemia prevalence and anemia-related unnecessary blood transfusion have been developed. (7) However, as the level of evidence is still low for some recommendations, further studies are needed to elucidate the potential role of these PBM measures. Furthermore, education remains paramount to the successful implementation of PBM programs and to improving patient outcomes.