patient blood management (PBM)

An overall framework to address the risks of iron deficiency, anaemia, blood loss and coagulopathy

Intro

‘Patient blood management addresses the problems of anaemia, blood loss and coagulopathy. It is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing a patient’s own blood through diagnosis and etiology-specific treatment of anaemia and preserving the patient’s own blood by minimizing blood loss and bleeding, while promoting patient safety and empowerment. It reduces the utilization of health care resources as well as expenditures, transfusion dependency, and the risks and complications of transfusion.’ (WHO policy brief 2021)

This page offers a few key resources discussing the importance of patient blood management. It is important to have a good understanding of PBM as it has a very wide-ranging scope and a particular focus on patient-centred care.

‘The Urgent Need to Implement Patient Blood Management’ (WHO policy brief 2021)

Core elements of PBM

  • ‘The use of every appropriate measure to protect and manage a patient’s own blood, in a manner that is tailored to the needs of the individual patient.’

  • ‘The overarching aim of PBM is to improve patient outcomes, while saving health care resources and reducing costs'.’

Three Pillars to achieve PBM

  1. Detection and management of anaemia and iron deficiency

  2. Minimisation of blood loss and optimisiation of coagulation

  3. Leveraging and opitmising the patient-specific physiological tolerance of anaemia

Other Themes include:

  • PBM has been developing over the last 40 years with ever increasing importance

  • Recognition that ‘our own blood is still the best thing to have in our veins’

  • PBM is a patient-centred approach to address iron deficiency, anaemia, blood loss & coagulopathy

  • Est. 2.9 billion people with anaemia worldwide

Key UK PBM resources

NHSBT PBM Website and Programme

Good summary site for important national reports / initiatives relating to transfusion

JPAC Wesbite

Includes Transfusion 2024 a report highlighting key priorities for clinical and laboratory transfusion practice over the 5 years from 2019, with four aims:

  1. PBM

  2. Laboratory safety

  3. Information Technology

  4. Research and Development

Some PBM-relevant trials/papers

Cochrane Review of transfusion thresholds

  • 2021 update is expected, current review is from 2016

  • Use of a 70-80g/l threshold reduces proportion of patients exposed to transfusion by 43%

  • Restrictive transfusion does not negatively affect 30-day mortality or morbidity

REALITY 2021 - Acute MI. Restrictive thresholds non-inferior

MINT study (in progress as of 2021) - Acute MI. Powered to detect superiority of restrictive threshold

Tay et al 2020 - HSCT. Restrictive non-inferior with no difference in QoL measures

REDDS 2020 - MDS. Feasability study. QoL measures better in liberal arm. REDDS-2 in progress

Other Haembase pages relevant to PBM

Pre-Op Anaemia

Iron Deficiency

SHOT summaries