Patient Blood Management

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 outcome.(1)

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.(2) Strategies to address these risks are referred to as the three pillars of patient blood management:

  • optimisation of blood volume and red cell mass
  • minimisation of blood loss
  • optimisation of the patient’s tolerance of anaemia
     

PBM incorporates proactive treatment regimes which are tailored to suit individual patients, using a multidisciplinary team approach 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
  • challenges of maintaining an adequate blood supply in the face of increased demand due to ageing population(3)

 

Within the surgical setting, employment of principles for patient blood management begins at the time of surgical booking and continues through to patient recovery, incorporating preoperative, intraoperative and postoperative measures.

Principles and strategies used for patient blood management are also relevant to non-surgical patients.

Patient Blood Management strategies are advancing and becoming a key area for improvement within the health sector both within Australia and internationally; with increasing demonstration that use of the methods results in:

  • increased patient satisfaction
  • decrease in the need for transfusion
  • improved patient outcomes
  • healthcare cost savings.(1)
     
References
  1. Society for the Advancement of Blood Management. Professional definition Patient Blood Management. [cited 2012 September 11]. Available from: http://www.sabm.org/
  2. Gombotz H, Rehak R, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion 2007;47:1468–1480.
  3. Thomson A, Farmer S, Hofmann A, Isbister J, Shander A. Patient Blood Management - a new paradigm for transfusion medicine? ISBT Science Series 2009;4:423–435.