What is Patient Blood Management?

Patient Blood Management (PBM) takes an individualised, multidisciplinary approach to the management of a patient’s blood, through assessment and the development of a management plan to:

• optimise a patient’s own blood (identify and address the health conditions that might lead to a blood transfusion such as anaemia or iron deficiency)
• minimise blood loss (such as surgical techniques that reduce blood loss)
• optimise tolerance of anaemia (with appropriate management, the body may tolerate anaemia without resorting to blood transfusion).

PBM should be the standard of care applied by all clinicians for patients facing a medical or surgical intervention who are at high risk of significant blood loss.

The best and safest blood for patients is their own circulating blood. PBM views a patient’s own blood as a valuable and unique natural resource that should be conserved and managed appropriately. Appropriate patient management requires a patient’s blood (circulatory system) to be considered in the same way as the management of all other body systems.

Research in Australia indicates that there is variation in prescribing practice in relation to blood and blood products, and that some transfusions may be unnecessary or could have been avoided.

Benefits of appropriate management through PBM

• Assessment and management of conditions that might lead to a blood transfusion (so that transfusions are undertaken only when appropriate).
• Improved patient outcomes, including few complications, faster recoveries and shorter stays in hospital.
• Reduced patient exposure to the potential risks from receiving blood and blood products from another person, including:
  • allergic and immunological complications – blood transfusion is essentially a liquid organ transplant and, as with any transplant, the body is programmed to react to something foreign
  • infectious risk – blood in Australia is very safe with donor blood carefully screened and tested. However, there remains the potential, although very low, that blood transfusions can transmit infectious disease such as bacteria, viruses and parasites
  • incorrect blood transfused – although strict procedures are used to ensure patients receive the correct blood product, the potential for a patient to receive the wrong blood (meant for someone else) still exists, which can result in serious medical problems.

What is anaemia?

Anaemia is a deficiency in the quality or number of blood cells. There are three main classes of anaemia: excessive blood loss (haemorrhage), excessive blood cell destruction (haemolysis) and deficient red blood cell production (ineffective haematopoiesis). As red blood cells carry oxygen bound to haemoglobin around the body, anaemia can lead to a shortage of oxygen (hypoxia). A patient’s anaemia can be identified on the basis of a reduced haemoglobin level in circulating blood. Anaemia can commonly be caused by iron deficiency from blood loss or dietary deficiency, chronic diseases, medications or infection. The cause of anaemia is often identified by an examination of red blood cells or haemoglobin, and an assessment of its clinical features.

Why is anaemia management important?

A systematic review of the evidence has found that preoperative anaemia is independently associated with an increased risk of morbidity and mortality. Preoperative anaemia has also been found to increase the likelihood of red blood cell transfusion, which has its own hazards. Anaemia management prior to elective surgery can improve a patient’s pre-surgery clinical status, and reduce post-surgery morbidity, mortality and length of stay in hospital.

It is important to establish a definitive diagnosis of anaemia, whether it is related to the patient’s current condition, and if it is correctable. While some forms of anaemia cannot be prevented (if caused by a failure in the cell production process), other forms, such as anaemia caused by blood loss and dietary deficiency, can be prevented and managed. Unless there is a primary disorder of the marrow or some influence suppressing marrow function, most forms of anaemia are correctable without red blood cell transfusion within two or three weeks. If surgery is urgent, red blood cell transfusion may be necessary. However, anaemia may recur in the weeks following surgery. If red blood cell transfusion is used to correct anaemia in the short term, the cause of the anaemia will need to be followed up and/or the anaemia monitored to ensure it is resolved.