Blood Management Standard

Background to this standard

Blood and blood products are a vital resource, sourced from the Australian and international donor community, and from commercial manufacture. The use of blood and blood products can be lifesaving, but there are also risks associated with their administration and use. Adverse outcomes can vary in frequency and severity, and include allergic and immunological complications, infections and incorrect blood transfusions.^1,2 Prescribing practices regarding blood vary widely, and a significant proportion of blood transfusions are unnecessary or could be avoided.³

The management of patients’ own blood, and the use of blood and blood products, are a critical component of health care. The National Blood Authority (NBA) manages the national blood supply to ensure that clinicians have reliable and efficient access to blood and blood products needed for patient care, and to ensure value for money. Blood and blood products are provided to patients free of charge, based on clinical need and appropriate clinical practice.

Transfusion should not be a default decision. It should:

• Be carefully considered
• Take into account all the available evidence-based blood management strategies
• Balance the evidence for efficacy and improved clinical outcome against the potential risks
• Consider patient values and choices.

Scope of this standard

The Blood Management Standard covers all elements in the blood management and clinical transfusion process. This includes the principles of patient blood management (PBM), which involves avoiding unnecessary exposure to blood components through appropriate clinical management of the patient and the use of other, non-blood treatments. Consideration of all treatment options should be covered in the organisation’s policies, procedures and protocols (Action 7.1), and in communication with patients about treatment options (Action 7.3).

The Blood Management Standard aims to ensure that patients (and carers) are engaged in decisions about their management and, if they receive blood and blood products, they do so appropriately and safely.

The Blood Management Standard requires clinician leaders and managers of a health service organisation to implement systems to ensure the safe, appropriate, efficient and effective use of blood and blood products. Clinicians and other members of the workforce should use the blood and blood product safety and quality systems.

The term ‘transfusion’ in this guide covers the administration of all blood and blood products, regardless of their route of administration. The blood and blood products governed under this standard include:

• Fresh blood components, such as
  • red blood cells (RBCs)
  • platelets
  • clinical fresh, frozen plasma
  • cryoprecipitate
  • cryodepleted plasma
• Plasma derivatives and recombinant products, such as
  • albumin
  • immunoglobulins, including immunoglobulin replacement therapy (for example, intravenous immunoglobulin) and hyperimmune globulins
  • coagulation proteins
  • coagulation and complement inhibitors.

Other products that are made or derived from human blood or plasma, such as some types of fibrin sealants (including Tisseel and Artiss), could be considered blood products. However, these products are not included in the scope of this standard, and it is not necessary to apply the actions of this standard to these products. However, ensuring safety and quality is important for all patient treatments. These products should meet safety and quality standards identified in the Medication Safety Standard, as well as any other relevant standards, including those relating to patient consent.

The Blood Management Standard relates to the management of patients’ own blood, pre-administration (including assessment of the patient’s bleeding risk) and administration, and management and use of blood and blood products.

Patient blood management

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

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, if not managed appropriately, might lead to a blood transfusion, such as anaemia or iron deficiency)
• Minimise blood loss (such as minimal blood draw techniques, point-of-care diagnostic testing, pharmacological strategies, cell salvage, and surgical techniques that reduce blood loss)
• Optimise tolerance of anaemia (with appropriate management, the body can be supported to 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.

With better management, patients usually require fewer transfusions of donated blood components, which avoids transfusion-associated complications. PBM is not an intervention or an alternative to allogeneic blood transfusion; it is sound, evidence-based clinical practice.⁴

Action 7.4 includes specific strategies for developing and implementing PBM strategies.

The National Blood Authority website provides more information on PBM and supporting resources.

Stewardship Statement

The Australian Health Ministers’ Conference Statement on National Stewardship Expectations for the Supply of Blood and Blood Products (the Stewardship Statement)⁵ outlines the expectations of clinicians with regard to the responsible, sustainable and appropriate use of blood and blood products. The Blood Management Standard builds on these expectations, and outlines the safety and quality expectations of health service organisations in PBM, and the management of blood and blood products.

The Stewardship Statement lists a number of principles, including the following:

• All blood and blood products are used in a clinically appropriate manner in accordance with relevant professional guidelines and standards
• Informed patient consent procedures are implemented for all patients
• Processes, programs and facilities are in place to minimise the wastage of blood products
• Facilities are accredited with the appropriate bodies to meet all safety and quality obligations
• Transfusion-related adverse event information is collected and managed according to state or territory requirements.

References

1. National Blood Authority Haemovigilance Advisory Committee. The Australian haemovigilance minimum data set: version 1. Canberra: National Blood Authority; 2015.
2. Australian Red Cross Blood Service. Classification and incidence of adverse events. Sydney: ARCBS; 2017 [cited 2017 Mar 22].
3. Thomson A, Farmer S, Hofmann A, Isbister J, Shander A. Patient blood management – a new paradigm for transfusion medicine? ISBT Science Series 2009;4(n2):423–35.
4. National Blood Authority. Patient blood management guidelines. Canberra: NBA; 2011-2016.
5. Australian Health Ministers’ Conference. Australian Health Ministers’ conference statement on national stewardship expectations for the supply of blood and blood products. Canberra: National Blood Authority; 2010.