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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(2) and the strategies to address these risks are referred to as the three pillars of patient blood management.
|Predictors for red blood cell transfusions||Strategies to address these risks|
|preoperative anaemia||optimisation of blood volume and red cell mass|
|volume of surgical blood loss||minimisation of blood loss|
|failure to adopt a more restrictive threshold for transfusion||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:
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: